- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.15 / $93.61 / $108.73
| Professional | | $44.15 | $93.61 | $108.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.33 / $51.33 / $51.33
| Professional | | $51.33 | $51.33 | $51.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.85 / $100.33 / $130.51
| Professional | | $58.85 | $100.33 | $130.51 |
- 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
- $53.35 / $62.39 / $67.28
| Professional | | $53.35 | $62.39 | $67.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.58 / $142.58 / $142.58
| Professional | | $142.58 | $142.58 | $142.58 |