- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $93.33 / $245.47
| Professional | | $58.88 | $93.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $125.89 / $181.97
| Professional | | $85.11 | $125.89 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $158.49 / $467.74
| Professional | | $95.50 | $158.49 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.18 / $107.15 / $218.78
| Professional | | $69.18 | $107.15 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $123.03 / $134.90
| Professional | | $93.33 | $123.03 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $177.83 / $177.83
| Professional | | $141.25 | $177.83 | $177.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $131.83
| Professional | | $131.83 | $131.83 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $125.89 / $851.14
| Professional | | $56.23 | $125.89 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $107.15 / $186.21
| Professional | | $56.23 | $107.15 | $186.21 |