- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.95 / $106.04 / $125.10
| Professional | | $48.95 | $106.04 | $125.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.08 / $100.08 / $100.08
| Professional | | $100.08 | $100.08 | $100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.29 / $58.29 / $58.29
| Professional | | $58.29 | $58.29 | $58.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.44 / $150.01 / $214.31
| Professional | | $121.44 | $150.01 | $214.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.58 / $71.27 / $106.22
| Professional | | $60.58 | $71.27 | $106.22 |