- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.68 / $148.58 / $228.58
| Professional | | $138.68 | $148.58 | $228.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.26 / $153.26 / $153.26
| Professional | | $153.26 | $153.26 | $153.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.50 / $147.16 / $214.50
| Professional | | $107.50 | $147.16 | $214.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.64 / $136.76 / $221.02
| Professional | | $96.64 | $136.76 | $221.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.75 / $155.19 / $204.34
| Professional | | $0.75 | $155.19 | $204.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.75 / $127.72 / $194.00
| Professional | | $0.75 | $127.72 | $194.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.57 / $132.53 / $237.52
| Professional | | $34.57 | $132.53 | $237.52 |