- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $75.86 / $234.42
| Professional | | $52.48 | $75.86 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $102.33 / $190.55
| Professional | | $75.86 | $102.33 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $64.57
| Professional | | $32.36 | $33.11 | $64.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $128.82 / $165.96
| Professional | | $83.18 | $128.82 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $112.20 / $158.49
| Professional | | $79.43 | $112.20 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $100.00 / $158.49
| Professional | | $56.23 | $100.00 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $79.43 / $112.20
| Professional | | $67.61 | $79.43 | $112.20 |