- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.81 / $71.70 / $103.73
| Professional | | $36.81 | $71.70 | $103.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.56 / $76.81 / $146.78
| Professional | | $41.56 | $76.81 | $146.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.38 / $81.73 / $171.30
| Professional | | $41.38 | $81.73 | $171.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.78 / $103.73 / $285.02
| Professional | | $51.78 | $103.73 | $285.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.54 / $125.91 / $174.46
| Professional | | $56.54 | $125.91 | $174.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.98 / $99.83 / $174.62
| Professional | | $69.98 | $99.83 | $174.62 |