- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.08 / $112.75 / $127.60
| Professional | | $69.08 | $112.75 | $127.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.78 / $108.46 / $204.47
| Professional | | $87.78 | $108.46 | $204.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.61 / $138.27 / $175.98
| Professional | | $126.61 | $138.27 | $175.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.93 / $150.83 / $226.27
| Professional | | $103.93 | $150.83 | $226.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.93 / $156.66 / $226.27
| Professional | | $103.93 | $156.66 | $226.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.21 / $136.60 / $192.73
| Professional | | $103.21 | $136.60 | $192.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.97 / $122.87 / $212.24
| Professional | | $89.97 | $122.87 | $212.24 |