- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $138.04 / $269.15
| Professional | | $52.48 | $138.04 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.92 / $97.72 / $131.83
| Professional | | $26.92 | $97.72 | $131.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.90 / $89.13 / $165.96
| Professional | | $30.90 | $89.13 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $89.13 / $181.97
| Professional | | $67.61 | $89.13 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.88 / $75.86 / $194.98
| Professional | | $58.88 | $75.86 | $194.98 |