- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.33 / $180.43 / $321.11
| Professional | | $120.33 | $180.43 | $321.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.99 / $378.96 / $1,806.72
| Professional | | $170.99 | $378.96 | $1,806.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.35 / $540.91 / $540.91
| Professional | | $448.35 | $540.91 | $540.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.22 / $320.54 / $682.51
| Professional | | $163.22 | $320.54 | $682.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.41 / $375.88 / $539.05
| Professional | | $290.41 | $375.88 | $539.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.97 / $356.55 / $684.75
| Professional | | $193.97 | $356.55 | $684.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.94 / $594.67 / $1,806.72
| Professional | | $233.94 | $594.67 | $1,806.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.44 / $363.89 / $984.42
| Professional | | $215.44 | $363.89 | $984.42 |