- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.48 / $48.78 / $75.55
| Professional | | $25.48 | $48.78 | $75.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.57 / $64.45 / $106.68
| Professional | | $34.57 | $64.45 | $106.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.40 / $66.59 / $143.31
| Professional | | $34.40 | $66.59 | $143.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.51 / $73.58 / $145.72
| Professional | | $37.51 | $73.58 | $145.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.48 / $48.78 / $82.31
| Professional | | $25.48 | $48.78 | $82.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.37 / $98.53 / $144.91
| Professional | | $58.37 | $98.53 | $144.91 |