- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.09 / $95.97 / $121.08
| Professional | | $74.09 | $95.97 | $121.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.26 / $154.94 / $238.72
| Professional | | $88.26 | $154.94 | $238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.36 / $182.89 / $215.55
| Professional | | $90.36 | $182.89 | $215.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.83 / $137.46 / $185.57
| Professional | | $95.83 | $137.46 | $185.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.75 / $159.57 / $229.68
| Professional | | $105.75 | $159.57 | $229.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.57 / $156.63 / $235.40
| Professional | | $95.57 | $156.63 | $235.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.36 / $153.69 / $273.41
| Professional | | $96.36 | $153.69 | $273.41 |