- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.95 / $118.13 / $160.41
| Professional | | $108.95 | $118.13 | $160.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.82 / $175.48 / $269.68
| Professional | | $111.82 | $175.48 | $269.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.17 / $96.61 / $169.94
| Professional | | $90.17 | $96.61 | $169.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.40 / $148.47 / $196.69
| Professional | | $103.40 | $148.47 | $196.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.49 / $152.49 / $269.17
| Professional | | $108.49 | $152.49 | $269.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.60 / $100.60 / $100.60
| Professional | | $100.60 | $100.60 | $100.60 |