- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.73 / $56.97 / $61.15
| Professional | | $53.73 | $56.97 | $61.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.58 / $112.36 / $140.44
| Professional | | $82.58 | $112.36 | $140.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.74 / $100.57 / $348.21
| Professional | | $53.74 | $100.57 | $348.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.00 / $105.60 / $118.54
| Professional | | $57.00 | $105.60 | $118.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.16 / $90.38 / $108.68
| Professional | | $62.16 | $90.38 | $108.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.80 / $95.15 / $119.22
| Professional | | $48.80 | $95.15 | $119.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.90 / $124.60 / $129.60
| Professional | | $105.90 | $124.60 | $129.60 |