- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $114.82 / $181.97
| Professional | | $85.11 | $114.82 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Professional | 25 | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $234.42 / $288.40
| Professional | | $208.93 | $234.42 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $165.96 / $575.44
| Facility | | $120.23 | $165.96 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $213.80 / $251.19
| Professional | | $158.49 | $213.80 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $194.98 / $245.47
| Professional | | $181.97 | $194.98 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $158.49 / $245.47
| Professional | | $144.54 | $158.49 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $346.74
| Professional | | $181.97 | $213.80 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $177.83 / $186.21
| Professional | | $177.83 | $177.83 | $186.21 |