- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.90 / $118.47 / $237.67
| Professional | | $82.90 | $118.47 | $237.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.51 / $177.14 / $257.51
| Professional | | $127.51 | $177.14 | $257.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.31 / $181.70 / $308.72
| Professional | | $103.31 | $181.70 | $308.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.99 / $194.93 / $351.65
| Professional | | $161.99 | $194.93 | $351.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.05 / $143.55 / $237.67
| Professional | | $100.05 | $143.55 | $237.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.06 / $154.18 / $319.22
| Professional | | $125.06 | $154.18 | $319.22 |