- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.25 / $86.44 / $112.49
| Professional | | $68.25 | $86.44 | $112.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.87 / $118.84 / $163.47
| Professional | | $97.87 | $118.84 | $163.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.37 / $94.29 / $173.48
| Professional | | $68.37 | $94.29 | $173.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.58 / $271.04 / $660.93
| Professional | | $118.58 | $271.04 | $660.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.49 / $137.38 / $212.06
| Professional | | $112.49 | $137.38 | $212.06 |