- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.62 / $116.32 / $182.66
| Professional | | $80.62 | $116.32 | $182.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.76 / $112.77 / $191.16
| Professional | | $72.76 | $112.77 | $191.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.02 / $125.58 / $125.58
| Professional | | $122.02 | $125.58 | $125.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.17 / $131.28 / $220.56
| Professional | | $86.17 | $131.28 | $220.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.33 / $139.13 / $206.73
| Professional | | $92.33 | $139.13 | $206.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.79 / $110.13 / $155.52
| Professional | | $81.79 | $110.13 | $155.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.63 / $131.33 / $221.82
| Professional | | $101.63 | $131.33 | $221.82 |