- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.66 / $67.61 / $134.90
| Professional | | $42.66 | $67.61 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $75.86 / $144.54
| Professional | | $57.54 | $75.86 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $112.20
| Professional | | $32.36 | $33.11 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $102.33 / $128.82
| Professional | | $70.79 | $102.33 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $81.28 / $144.54
| Professional | | $51.29 | $81.28 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $100.00 / $151.36
| Professional | | $60.26 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $69.18 / $117.49
| Professional | | $47.86 | $69.18 | $117.49 |