- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $114.82 / $194.98
| Professional | | $50.12 | $114.82 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $104.71 / $204.17
| Professional | | $53.70 | $104.71 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $151.36 / $309.03
| Professional | | $57.54 | $151.36 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $151.36 / $338.84
| Professional | | $57.54 | $151.36 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $131.83 / $354.81
| Professional | | $52.48 | $131.83 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $120.23 / $281.84
| Professional | | $56.23 | $120.23 | $281.84 |