- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $239.88 / $549.54
| Professional | | $128.82 | $239.88 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $281.84 / $602.56
| Professional | | $223.87 | $281.84 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $346.74
| Professional | | $181.97 | $181.97 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $331.13 / $870.96
| Professional | | $154.88 | $331.13 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $346.74 / $501.19
| Professional | | $263.03 | $346.74 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $323.59 / $524.81
| Professional | | $181.97 | $323.59 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $354.81 / $512.86
| Professional | | $295.12 | $354.81 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $218.78 / $562.34
| Professional | | $112.20 | $218.78 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $295.12 / $524.81
| Professional | | $181.97 | $295.12 | $524.81 |