- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.21 / $63.57 / $70.75
| Professional | | $33.21 | $63.57 | $70.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.88 / $37.88 / $37.88
| Professional | | $37.88 | $37.88 | $37.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.59 / $60.67 / $78.92
| Professional | | $35.59 | $60.67 | $78.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.83 / $152.83 / $152.83
| Professional | | $152.83 | $152.83 | $152.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.89 / $39.36 / $50.29
| Professional | | $33.89 | $39.36 | $50.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.23 / $105.23 / $105.23
| Professional | | $105.23 | $105.23 | $105.23 |