- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.60 / $73.05 / $84.85
| Professional | | $36.60 | $73.05 | $84.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.55 / $42.55 / $42.55
| Professional | | $42.55 | $42.55 | $42.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.34 / $70.48 / $91.68
| Professional | | $41.34 | $70.48 | $91.68 |
- 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
- $39.36 / $44.79 / $52.60
| Professional | | $39.36 | $44.79 | $52.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.19 / $118.19 / $118.19
| Professional | | $118.19 | $118.19 | $118.19 |