- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.92 / $146.68 / $251.01
| Professional | | $107.92 | $146.68 | $251.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.57 / $146.99 / $223.25
| Professional | | $100.57 | $146.99 | $223.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.45 / $138.72 / $212.98
| Professional | | $87.45 | $138.72 | $212.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.57 / $145.28 / $242.62
| Professional | | $0.57 | $145.28 | $242.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.13 / $104.97 / $144.19
| Professional | | $96.13 | $104.97 | $144.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.16 / $157.91 / $241.84
| Professional | | $122.16 | $157.91 | $241.84 |