- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.33 / $67.93 / $75.28
| Professional | | $34.33 | $67.93 | $75.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.71 / $38.71 / $38.71
| Professional | | $38.71 | $38.71 | $38.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.69 / $67.67 / $88.02
| Professional | | $39.69 | $67.67 | $88.02 |
- 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
- $37.79 / $43.00 / $51.05
| Professional | | $37.79 | $43.00 | $51.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.53 / $107.53 / $107.53
| Professional | | $107.53 | $107.53 | $107.53 |