- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.44 / $86.23 / $346.81
| Professional | | $52.44 | $86.23 | $346.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.94 / $248.52 / $269.66
| Professional | | $156.94 | $248.52 | $269.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.75 / $121.92 / $146.06
| Professional | | $54.75 | $121.92 | $146.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.81 / $151.11 / $182.50
| Professional | | $91.81 | $151.11 | $182.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.36 / $137.28 / $201.14
| Professional | | $87.36 | $137.28 | $201.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.84 / $147.84 / $147.84
| Professional | | $147.84 | $147.84 | $147.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.93 / $145.07 / $186.48
| Professional | | $84.93 | $145.07 | $186.48 |