- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $67.61 / $83.18
| Professional | | $52.48 | $67.61 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $186.21 / $269.15
| Professional | | $107.15 | $186.21 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.61 / $177.83 / $295.12
| Professional | | $67.61 | $177.83 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $190.55 / $257.04
| Professional | | $114.82 | $190.55 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.95 / $93.33 / $245.47
| Professional | | $54.95 | $93.33 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $95.50 / $194.98
| Professional | | $56.23 | $95.50 | $194.98 |