- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.60 / $100.85 / $130.62
| Professional | | $49.60 | $100.85 | $130.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.66 / $57.66 / $57.66
| Professional | | $57.66 | $57.66 | $57.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.80 / $120.71 / $157.02
| Professional | | $70.80 | $120.71 | $157.02 |
- 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
- $59.93 / $74.54 / $81.08
| Professional | | $59.93 | $74.54 | $81.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.15 / $160.15 / $160.15
| Professional | | $160.15 | $160.15 | $160.15 |