- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.04 / $72.56 / $163.92
| Professional | | $35.04 | $72.56 | $163.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.25 / $77.28 / $145.07
| Professional | | $58.25 | $77.28 | $145.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.84 / $32.34 / $71.91
| Professional | | $24.84 | $32.34 | $71.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.73 / $72.45 / $150.56
| Professional | | $62.73 | $72.45 | $150.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.25 / $100.45 / $148.78
| Professional | | $62.25 | $100.45 | $148.78 |