- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.59 / $106.28 / $158.83
| Professional | | $78.59 | $106.28 | $158.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.14 / $135.37 / $189.63
| Professional | | $100.14 | $135.37 | $189.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.92 / $135.74 / $228.25
| Professional | | $87.92 | $135.74 | $228.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.74 / $149.58 / $331.25
| Professional | | $86.74 | $149.58 | $331.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $179.43
| Professional | | $32.34 | $32.34 | $179.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.63 / $137.16 / $204.71
| Professional | | $107.63 | $137.16 | $204.71 |