- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.17 / $76.97 / $122.97
| Professional | | $48.17 | $76.97 | $122.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.12 / $166.05 / $276.83
| Professional | | $93.12 | $166.05 | $276.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.28 / $187.42 / $345.07
| Professional | | $107.28 | $187.42 | $345.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.22 / $176.06 / $317.48
| Professional | | $106.22 | $176.06 | $317.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.81 / $154.29 / $368.32
| Professional | | $83.81 | $154.29 | $368.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.81 / $144.76 / $289.83
| Professional | | $83.81 | $144.76 | $289.83 |