- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.94 / $117.89 / $166.58
| Professional | | $46.94 | $117.89 | $166.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.64 / $92.56 / $163.88
| Professional | | $42.64 | $92.56 | $163.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20.98 / $30.26 / $181.93
| Professional | | $20.98 | $30.26 | $181.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.91 / $138.05 / $267.82
| Professional | | $55.91 | $138.05 | $267.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $109.01
| Professional | | $32.34 | $32.34 | $109.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.38 / $139.41 / $196.26
| Professional | | $93.38 | $139.41 | $196.26 |