- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.44 / $70.77 / $111.04
| Professional | | $37.44 | $70.77 | $111.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.47 / $137.77 / $390.24
| Professional | | $113.47 | $137.77 | $390.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.86 / $104.96 / $309.02
| Professional | | $39.86 | $104.96 | $309.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.66 / $112.87 / $309.02
| Professional | | $53.66 | $112.87 | $309.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.96 / $123.41 / $436.74
| Professional | | $85.96 | $123.41 | $436.74 |