- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.47 / $167.28 / $299.68
| Professional | | $125.47 | $167.28 | $299.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.48 / $165.20 / $208.92
| Professional | | $118.48 | $165.20 | $208.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.96 / $174.65 / $174.65
| Professional | | $131.96 | $174.65 | $174.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.25 / $131.88 / $243.56
| Professional | | $103.25 | $131.88 | $243.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.08 / $189.84 / $239.65
| Professional | | $116.08 | $189.84 | $239.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.89 / $213.73 / $240.26
| Professional | | $173.89 | $213.73 | $240.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.68 / $138.27 / $207.77
| Professional | | $115.68 | $138.27 | $207.77 |