- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.91 / $116.24 / $217.96
| Professional | | $52.91 | $116.24 | $217.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.64 / $103.89 / $195.90
| Professional | | $60.64 | $103.89 | $195.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.03 / $139.44 / $285.97
| Professional | | $62.03 | $139.44 | $285.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.65 / $154.16 / $273.62
| Professional | | $62.65 | $154.16 | $273.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.35 / $72.18 / $217.96
| Professional | | $59.35 | $72.18 | $217.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.54 / $167.79 / $259.70
| Professional | | $120.54 | $167.79 | $259.70 |