- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $114.82 / $245.47
| Professional | | $77.62 | $114.82 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $151.36 / $380.19
| Professional | | $89.13 | $151.36 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $173.78 / $309.03
| Professional | | $91.20 | $173.78 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $199.53 / $257.04
| Professional | | $162.18 | $199.53 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $363.08
| Professional | | $97.72 | $177.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $147.91 / $380.19
| Professional | | $89.13 | $147.91 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $158.49 / $346.74
| Professional | | $95.50 | $158.49 | $346.74 |