- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $251.19 / $309.03
| Professional | | $77.62 | $251.19 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $512.86 / $912.01
| Professional | | $199.53 | $512.86 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $562.34 / $2,238.72
| Professional | | $218.78 | $562.34 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $218.78 / $660.69
| Professional | | $194.98 | $218.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $602.56
| Professional | | $194.98 | $194.98 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $302.00 / $588.84
| Professional | | $147.91 | $302.00 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $263.03 / $812.83
| Professional | | $120.23 | $263.03 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $194.98 / $660.69
| Professional | | $158.49 | $194.98 | $660.69 |