- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $42.66 / $52.48
| Professional | | $32.36 | $42.66 | $52.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $141.25 / $204.17
| Professional | | $81.28 | $141.25 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $134.90 / $229.09
| Professional | | $52.48 | $134.90 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $144.54 / $194.98
| Professional | | $67.61 | $144.54 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.84 / $51.29 / $128.82
| Professional | | $28.84 | $51.29 | $128.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $54.95 / $128.82
| Professional | | $30.20 | $54.95 | $128.82 |