- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.26 / $127.98 / $199.69
| Professional | | $78.26 | $127.98 | $199.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.20 / $109.13 / $141.79
| Professional | | $68.20 | $109.13 | $141.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.50 / $122.70 / $242.95
| Professional | | $59.50 | $122.70 | $242.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.88 / $168.16 / $253.50
| Professional | | $108.88 | $168.16 | $253.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.94 / $115.62 / $205.22
| Professional | | $68.94 | $115.62 | $205.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.70 / $140.38 / $191.80
| Professional | | $88.70 | $140.38 | $191.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.64 / $156.97 / $254.78
| Professional | | $102.64 | $156.97 | $254.78 |