- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $67.61 / $151.36
| Professional | | $45.71 | $67.61 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $81.28 / $120.23
| Professional | | $46.77 | $81.28 | $120.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $91.20 / $147.91
| Professional | | $60.26 | $91.20 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.70 / $91.20 / $144.54
| Professional | | $53.70 | $91.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $67.61 / $169.82
| Professional | | $47.86 | $67.61 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $83.18 / $144.54
| Professional | | $57.54 | $83.18 | $144.54 |