- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.05 / $104.83 / $253.73
| Professional | | $64.05 | $104.83 | $253.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.83 / $178.83 / $289.94
| Professional | | $103.83 | $178.83 | $289.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.30 / $197.63 / $315.27
| Professional | | $120.30 | $197.63 | $315.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.87 / $187.01 / $366.89
| Professional | | $118.87 | $187.01 | $366.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.68 / $167.18 / $294.38
| Professional | | $113.68 | $167.18 | $294.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.31 / $102.37 / $161.58
| Professional | | $85.31 | $102.37 | $161.58 |