- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.74 / $111.95 / $159.44
| Professional | | $56.74 | $111.95 | $159.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.76 / $230.81 / $994.59
| Professional | | $81.76 | $230.81 | $994.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.98 / $88.98 / $88.98
| Professional | | $88.98 | $88.98 | $88.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.93 / $117.61 / $161.53
| Professional | | $86.93 | $117.61 | $161.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.47 / $242.78 / $310.83
| Professional | | $122.47 | $242.78 | $310.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.31 / $230.81 / $994.59
| Professional | | $70.31 | $230.81 | $994.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.31 / $171.63 / $320.87
| Professional | | $70.31 | $171.63 | $320.87 |