- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $251.19 / $575.44
| Professional | | $154.88 | $251.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $245.47 / $630.96
| Professional | | $199.53 | $245.47 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $229.09 / $371.54
| Professional | | $229.09 | $229.09 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $331.13 / $870.96
| Professional | | $181.97 | $331.13 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $416.87 / $602.56
| Professional | | $302.00 | $416.87 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $338.84 / $549.54
| Professional | | $204.17 | $338.84 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $398.11 / $575.44
| Professional | | $302.00 | $398.11 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $257.04 / $660.69
| Professional | | $147.91 | $257.04 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $549.54
| Professional | | $208.93 | $309.03 | $549.54 |