- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.75 / $70.28 / $145.07
| Professional | | $41.75 | $70.28 | $145.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.77 / $59.73 / $89.78
| Professional | | $50.77 | $59.73 | $89.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.07 / $104.39 / $206.21
| Professional | | $57.07 | $104.39 | $206.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.47 / $113.36 / $181.99
| Professional | | $56.47 | $113.36 | $181.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.75 / $70.28 / $150.01
| Professional | | $41.75 | $70.28 | $150.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.17 / $168.57 / $210.72
| Professional | | $101.17 | $168.57 | $210.72 |