- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.84 / $116.05 / $327.52
| Professional | | $86.84 | $116.05 | $327.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.03 / $124.65 / $195.93
| Professional | | $94.03 | $124.65 | $195.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.40 / $126.17 / $189.31
| Professional | | $90.40 | $126.17 | $189.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.04 / $108.87 / $331.76
| Professional | | $1.04 | $108.87 | $331.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.78 / $102.82 / $382.80
| Professional | | $0.78 | $102.82 | $382.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.66 / $113.68 / $204.75
| Professional | | $88.66 | $113.68 | $204.75 |