- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.56 / $107.03 / $459.67
| Professional | | $72.56 | $107.03 | $459.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.20 / $181.77 / $255.31
| Professional | | $71.20 | $181.77 | $255.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.53 / $103.80 / $209.51
| Professional | | $66.53 | $103.80 | $209.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.56 / $107.75 / $137.66
| Professional | | $83.56 | $107.75 | $137.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.08 / $161.44 / $328.59
| Professional | | $161.08 | $161.44 | $328.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.87 / $92.93 / $177.46
| Professional | | $66.87 | $92.93 | $177.46 |