- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.46 / $189.07 / $310.61
| Professional | | $101.46 | $189.07 | $310.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.60 / $429.52 / $1,647.76
| Professional | | $211.60 | $429.52 | $1,647.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.94 / $293.31 / $613.73
| Professional | | $154.94 | $293.31 | $613.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.75 / $321.25 / $443.45
| Professional | | $253.75 | $321.25 | $443.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.12 / $349.72 / $614.86
| Professional | | $167.12 | $349.72 | $614.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.94 / $471.68 / $1,647.76
| Professional | | $212.94 | $471.68 | $1,647.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.36 / $340.44 / $791.63
| Professional | | $190.36 | $340.44 | $791.63 |