- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.67 / $148.88 / $190.28
| Professional | | $40.67 | $148.88 | $190.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.01 / $101.86 / $248.37
| Professional | | $49.01 | $101.86 | $248.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.27 / $141.69 / $367.22
| Professional | | $49.27 | $141.69 | $367.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.29 / $165.72 / $337.08
| Professional | | $50.29 | $165.72 | $337.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.67 / $97.58 / $190.28
| Professional | | $40.67 | $97.58 | $190.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.66 / $214.37 / $331.85
| Professional | | $125.66 | $214.37 | $331.85 |