- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.20 / $268.52 / $385.44
| Professional | | $196.20 | $268.52 | $385.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.62 / $473.10 / $1,806.80
| Professional | | $236.62 | $473.10 | $1,806.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.30 / $456.66 / $1,037.98
| Professional | | $278.30 | $456.66 | $1,037.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.86 / $166.80 / $391.56
| Professional | | $40.86 | $166.80 | $391.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.07 / $585.13 / $810.86
| Professional | | $310.07 | $585.13 | $810.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.45 / $490.03 / $1,806.80
| Professional | | $267.45 | $490.03 | $1,806.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.07 / $400.01 / $866.87
| Professional | | $254.07 | $400.01 | $866.87 |