- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $85.11 / $151.36
| Professional | | $46.77 | $85.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $91.20 / $151.36
| Professional | | $46.77 | $91.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $107.15 / $177.83
| Professional | | $60.26 | $107.15 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $117.49 / $181.97
| Professional | | $51.29 | $117.49 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $107.15 / $223.87
| Professional | | $53.70 | $107.15 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $93.33 / $181.97
| Professional | | $56.23 | $93.33 | $181.97 |