- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $75.86 / $162.18
| Professional | | $46.77 | $75.86 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.57 / $117.49 / $199.53
| Professional | | $64.57 | $117.49 | $199.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $131.83 / $213.80
| Professional | | $87.10 | $131.83 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $125.89 / $194.98
| Professional | | $79.43 | $125.89 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $120.23 / $194.98
| Professional | | $79.43 | $120.23 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $138.04 / $204.17
| Professional | | $91.20 | $138.04 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $114.82 / $186.21
| Professional | | $70.79 | $114.82 | $186.21 |