- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.91 / $71.59 / $135.03
| Professional | | $55.91 | $71.59 | $135.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.49 / $110.27 / $137.84
| Professional | | $89.49 | $110.27 | $137.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.76 / $105.79 / $374.39
| Professional | | $64.76 | $105.79 | $374.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.88 / $116.70 / $148.88
| Professional | | $89.88 | $116.70 | $148.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.34 / $89.08 / $102.64
| Professional | | $71.34 | $89.08 | $102.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.84 / $98.73 / $124.60
| Professional | | $65.84 | $98.73 | $124.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.00 / $121.10 / $121.10
| Professional | | $99.00 | $121.10 | $121.10 |