- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.68 / $59.35 / $122.92
| Professional | | $40.68 | $59.35 | $122.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.85 / $70.93 / $94.44
| Professional | | $48.85 | $70.93 | $94.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.68 / $75.64 / $130.27
| Professional | | $50.68 | $75.64 | $130.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.84 / $58.52 / $74.16
| Professional | | $49.84 | $58.52 | $74.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.86 / $78.01 / $143.90
| Professional | | $47.86 | $78.01 | $143.90 |