- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.42 / $286.02 / $580.48
| Professional | | $190.42 | $286.02 | $580.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.52 / $595.62 / $1,678.62
| Professional | | $248.52 | $595.62 | $1,678.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.43 / $635.78 / $1,248.71
| Professional | | $271.43 | $635.78 | $1,248.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.30 / $1,057.55 / $2,222.08
| Professional | | $304.30 | $1,057.55 | $2,222.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.22 / $219.47 / $583.02
| Professional | | $32.22 | $219.47 | $583.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.20 / $685.67 / $1,020.90
| Professional | | $433.20 | $685.67 | $1,020.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.57 / $1,277.46 / $2,222.08
| Professional | | $310.57 | $1,277.46 | $2,222.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $767.30 / $994.27 / $1,524.71
| Professional | | $767.30 | $994.27 | $1,524.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.30 / $610.92 / $1,396.39
| Professional | | $304.30 | $610.92 | $1,396.39 |