- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $154.88 / $323.59
| Professional | | $123.03 | $154.88 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $281.84 / $398.11
| Professional | | $151.36 | $281.84 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $239.88 / $316.23
| Professional | | $181.97 | $239.88 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $234.42 / $346.74
| Professional | | $186.21 | $234.42 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $251.19 / $354.81
| Professional | | $79.43 | $251.19 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $281.84 / $354.81
| Professional | | $245.47 | $281.84 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $263.03 / $354.81
| Professional | | $165.96 | $263.03 | $354.81 |