- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.02 / $131.83 / $275.42
| Professional | | $38.02 | $131.83 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $120.23 / $263.03
| Professional | | $45.71 | $120.23 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $131.83 / $309.03
| Professional | | $42.66 | $131.83 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $234.42 / $407.38
| Professional | | $53.70 | $234.42 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.98 / $50.12 / $204.17
| Professional | | $48.98 | $50.12 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $213.80
| Professional | | $32.36 | $33.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.81 / $102.33 / $239.88
| Professional | | $39.81 | $102.33 | $239.88 |