- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.78 / $87.92 / $192.45
| Professional | | $42.78 | $87.92 | $192.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.70 / $101.48 / $176.78
| Professional | | $61.70 | $101.48 | $176.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.85 / $106.14 / $224.94
| Professional | | $57.85 | $106.14 | $224.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.30 / $121.93 / $241.51
| Professional | | $64.30 | $121.93 | $241.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.78 / $87.92 / $198.69
| Professional | | $42.78 | $87.92 | $198.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.28 / $139.97 / $237.37
| Professional | | $104.28 | $139.97 | $237.37 |