- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.57 / $120.95 / $173.73
| Professional | | $45.57 | $120.95 | $173.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.01 / $186.80 / $272.14
| Professional | | $138.01 | $186.80 | $272.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.46 / $209.28 / $404.86
| Professional | | $51.46 | $209.28 | $404.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.82 / $195.93 / $353.45
| Professional | | $162.82 | $195.93 | $353.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.94 / $130.25 / $173.73
| Professional | | $46.94 | $130.25 | $173.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.96 / $195.87 / $293.31
| Professional | | $160.96 | $195.87 | $293.31 |