- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $144.54 / $295.12
| Professional | | $97.72 | $144.54 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $229.09 / $363.08
| Professional | | $128.82 | $229.09 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $380.19
| Professional | | $181.97 | $257.04 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $239.88 / $363.08
| Professional | | $165.96 | $239.88 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $239.88 / $363.08
| Professional | | $79.43 | $239.88 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $269.15 / $363.08
| Professional | | $194.98 | $269.15 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $354.81
| Professional | | $151.36 | $229.09 | $354.81 |