- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.59 / $97.99 / $129.91
| Professional | | $78.59 | $97.99 | $129.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.88 / $92.88 / $123.36
| Professional | | $92.88 | $92.88 | $123.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.40 / $115.92 / $234.17
| Professional | | $86.40 | $115.92 | $234.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.37 / $121.73 / $209.67
| Professional | | $87.37 | $121.73 | $209.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.65 / $135.90 / $185.79
| Facility | | $97.65 | $135.90 | $185.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.90 / $136.13 / $180.81
| Professional | | $105.90 | $136.13 | $180.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.92 / $114.99 / $153.58
| Professional | | $84.92 | $114.99 | $153.58 |