- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.93 / $80.84 / $188.47
| Professional | | $41.93 | $80.84 | $188.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.87 / $104.60 / $182.37
| Professional | | $56.87 | $104.60 | $182.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.68 / $104.02 / $242.23
| Professional | | $56.68 | $104.02 | $242.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.48 / $125.78 / $249.14
| Professional | | $63.48 | $125.78 | $249.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.92 / $92.97 / $188.47
| Professional | | $41.92 | $92.97 | $188.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.11 / $163.19 / $247.68
| Professional | | $98.11 | $163.19 | $247.68 |