- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.84 / $210.24 / $735.26
| Professional | | $126.84 | $210.24 | $735.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.72 / $135.71 / $160.72
| Professional | | $110.72 | $135.71 | $160.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.01 / $213.46 / $264.06
| Professional | | $140.01 | $213.46 | $264.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.17 / $171.62 / $242.31
| Professional | | $127.17 | $171.62 | $242.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.25 / $152.94 / $230.09
| Professional | | $1.25 | $152.94 | $230.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.25 / $119.06 / $199.50
| Professional | | $1.25 | $119.06 | $199.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.12 / $170.59 / $265.14
| Professional | | $120.12 | $170.59 | $265.14 |