- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $204.17 / $354.81
| Professional | | $125.89 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $234.42
| Professional | | $194.98 | $194.98 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $467.74
| Professional | | $144.54 | $245.47 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $169.82 / $218.78
| Professional | | $158.49 | $169.82 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $269.15
| Professional | | $32.36 | $33.11 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $213.80 / $389.05
| Professional | | $125.89 | $213.80 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $173.78 / $229.09
| Professional | | $112.20 | $173.78 | $229.09 |