- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.28 / $75.81 / $259.91
| Professional | | $46.28 | $75.81 | $259.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.56 / $80.66 / $110.33
| Professional | | $44.56 | $80.66 | $110.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.46 / $52.39 / $117.86
| Professional | | $17.46 | $52.39 | $117.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.21 / $81.56 / $110.33
| Professional | | $45.21 | $81.56 | $110.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.22 / $87.22 / $125.27
| Professional | | $66.22 | $87.22 | $125.27 |