- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.55 / $59.52 / $112.65
| Professional | | $46.55 | $59.52 | $112.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.61 / $39.96 / $180.84
| Professional | | $33.61 | $39.96 | $180.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.82 / $74.93 / $156.96
| Professional | | $41.82 | $74.93 | $156.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.61 / $74.56 / $141.78
| Professional | | $57.61 | $74.56 | $141.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.91 / $71.34 / $151.24
| Professional | | $49.91 | $71.34 | $151.24 |