- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.91 / $197.29 / $314.02
| Professional | | $131.91 | $197.29 | $314.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.80 / $239.66 / $363.99
| Professional | | $203.80 | $239.66 | $363.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.59 / $93.16 / $172.74
| Professional | | $79.59 | $93.16 | $172.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.10 / $262.80 / $464.28
| Professional | | $169.10 | $262.80 | $464.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.74 / $262.80 / $464.87
| Professional | | $172.74 | $262.80 | $464.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.54 / $98.98 / $226.80
| Professional | | $62.54 | $98.98 | $226.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.38 / $222.50 / $388.66
| Professional | | $173.38 | $222.50 | $388.66 |