- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.62 / $49.25 / $177.39
| Professional | | $31.62 | $49.25 | $177.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.46 / $64.00 / $102.95
| Professional | | $33.46 | $64.00 | $102.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.27 / $101.41 / $147.76
| Professional | | $54.27 | $101.41 | $147.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.80 / $105.62 / $256.32
| Professional | | $62.80 | $105.62 | $256.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.53 / $99.49 / $138.43
| Professional | | $67.53 | $99.49 | $138.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.75 / $62.26 / $108.27
| Professional | | $33.75 | $62.26 | $108.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.80 / $105.62 / $135.27
| Professional | | $62.80 | $105.62 | $135.27 |