- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $223.87 / $1,148.15
| Professional | | $134.90 | $223.87 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $194.98 / $281.84
| Professional | | $125.89 | $194.98 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $223.87 / $346.74
| Professional | | $131.83 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $371.54
| Professional | | $131.83 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $275.42 / $346.74
| Professional | | $199.53 | $275.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $234.42
| Professional | | $131.83 | $234.42 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $229.09 / $354.81
| Professional | | $141.25 | $229.09 | $354.81 |