- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.64 / $125.37 / $471.60
| Professional | | $94.64 | $125.37 | $471.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.73 / $191.63 / $832.84
| Professional | | $126.73 | $191.63 | $832.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.39 / $316.58 / $535.41
| Professional | | $189.39 | $316.58 | $535.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.55 / $261.94 / $486.82
| Professional | | $163.55 | $261.94 | $486.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.65 / $221.95 / $349.90
| Professional | | $175.65 | $221.95 | $349.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.32 / $335.04 / $462.70
| Professional | | $184.32 | $335.04 | $462.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.93 / $207.82 / $832.84
| Professional | | $137.93 | $207.82 | $832.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.93 / $185.17 / $509.65
| Professional | | $137.93 | $185.17 | $509.65 |