- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.37 / $54.53 / $346.81
| Professional | | $51.37 | $54.53 | $346.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.22 / $56.73 / $109.65
| Professional | | $48.22 | $56.73 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.18 / $78.72 / $138.50
| Professional | | $54.18 | $78.72 | $138.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.37 / $58.32 / $346.81
| Professional | | $51.37 | $58.32 | $346.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.18 / $102.03 / $160.81
| Professional | | $54.18 | $102.03 | $160.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.12 / $53.12 / $64.52
| Professional | | $53.12 | $53.12 | $64.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.50 / $80.53 / $127.76
| Professional | | $57.50 | $80.53 | $127.76 |