- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $223.87 / $691.83
| Professional | | $125.89 | $223.87 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $229.09 / $239.88
| Professional | | $194.98 | $229.09 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $190.55 / $281.84
| Professional | | $123.03 | $190.55 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $354.81
| Professional | | $147.91 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $194.98 / $302.00
| Professional | | $165.96 | $194.98 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $125.89 / $676.08
| Professional | | $123.03 | $125.89 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $190.55 / $257.04
| Professional | | $134.90 | $190.55 | $257.04 |