- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.87 / $96.72 / $156.47
| Professional | | $48.87 | $96.72 | $156.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.33 / $181.83 / $368.35
| Professional | | $98.33 | $181.83 | $368.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.07 / $205.74 / $410.72
| Professional | | $105.07 | $205.74 | $410.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.03 / $193.20 / $349.62
| Professional | | $104.03 | $193.20 | $349.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.71 / $197.45 / $406.46
| Professional | | $103.71 | $197.45 | $406.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.21 / $184.02 / $377.42
| Professional | | $101.21 | $184.02 | $377.42 |