- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.67 / $70.40 / $130.37
| Professional | | $59.67 | $70.40 | $130.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.47 / $96.38 / $133.52
| Professional | | $74.47 | $96.38 | $133.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.20 / $111.62 / $157.68
| Professional | | $84.20 | $111.62 | $157.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.91 / $98.24 / $150.71
| Professional | | $84.91 | $98.24 | $150.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.67 / $83.37 / $130.37
| Professional | | $59.67 | $83.37 | $130.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.59 / $104.36 / $150.71
| Professional | | $69.59 | $104.36 | $150.71 |