- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.73 / $74.47 / $149.16
| Professional | | $57.73 | $74.47 | $149.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.05 / $56.26 / $80.34
| Professional | | $47.05 | $56.26 | $80.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.17 / $88.14 / $154.94
| Professional | | $59.17 | $88.14 | $154.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.60 / $61.71 / $83.85
| Professional | | $30.60 | $61.71 | $83.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.71 / $72.97 / $111.61
| Professional | | $52.71 | $72.97 | $111.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.97 / $75.42 / $119.46
| Professional | | $51.97 | $75.42 | $119.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.47 / $46.47 / $56.26
| Professional | | $46.47 | $46.47 | $56.26 |