- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.60 / $70.72 / $98.56
| Professional | | $49.60 | $70.72 | $98.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.40 / $160.15 / $160.15
| Professional | | $156.40 | $160.15 | $160.15 |
- 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
- $126.46 / $126.46 / $126.46
| Professional | | $126.46 | $126.46 | $126.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.58 / $77.37 / $93.05
| Professional | | $51.58 | $77.37 | $93.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.78 / $116.36 / $148.09
| Professional | | $105.78 | $116.36 | $148.09 |