- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.66 / $107.29 / $172.95
| Professional | | $92.66 | $107.29 | $172.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.13 / $153.10 / $263.95
| Professional | | $130.13 | $153.10 | $263.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.47 / $192.56 / $192.56
| Professional | | $180.47 | $192.56 | $192.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.81 / $131.03 / $214.53
| Professional | | $102.81 | $131.03 | $214.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.24 / $128.08 / $162.25
| Professional | | $101.24 | $128.08 | $162.25 |