- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.78 / $77.68 / $99.87
| Professional | | $56.78 | $77.68 | $99.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.06 / $58.00 / $131.27
| Professional | | $27.06 | $58.00 | $131.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.62 / $68.27 / $111.76
| Professional | | $48.62 | $68.27 | $111.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $90.00 / $128.44
| Professional | | $32.34 | $90.00 | $128.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.62 / $68.27 / $111.76
| Professional | | $48.62 | $68.27 | $111.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.79 / $77.00 / $124.21
| Professional | | $44.79 | $77.00 | $124.21 |