- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.69 / $132.63 / $276.14
| Professional | | $89.69 | $132.63 | $276.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.93 / $299.95 / $439.22
| Professional | | $239.93 | $299.95 | $439.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.01 / $400.93 / $1,128.08
| Professional | | $178.01 | $400.93 | $1,128.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.00 / $282.80 / $397.54
| Professional | | $211.00 | $282.80 | $397.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.63 / $218.96 / $293.69
| Professional | | $149.63 | $218.96 | $293.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.01 / $285.97 / $418.88
| Professional | | $178.01 | $285.97 | $418.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.50 / $236.80 / $342.30
| Professional | | $193.50 | $236.80 | $342.30 |