- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.79 / $73.20 / $257.67
| Professional | | $44.79 | $73.20 | $257.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.79 / $86.30 / $126.12
| Professional | | $58.79 | $86.30 | $126.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.11 / $89.98 / $110.30
| Professional | | $70.11 | $89.98 | $110.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.34 / $109.67 / $176.23
| Professional | | $65.34 | $109.67 | $176.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.41 / $78.48 / $126.45
| Professional | | $64.41 | $78.48 | $126.45 |