- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.28 / $128.66 / $256.77
| Professional | | $120.28 | $128.66 | $256.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.47 / $349.07 / $436.33
| Professional | | $285.47 | $349.07 | $436.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.28 / $223.51 / $268.98
| Professional | | $137.28 | $223.51 | $268.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.41 / $268.98 / $341.52
| Professional | | $216.41 | $268.98 | $341.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.63 / $217.04 / $291.11
| Professional | | $140.63 | $217.04 | $291.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.28 / $173.36 / $345.10
| Professional | | $137.28 | $173.36 | $345.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.30 / $326.30 / $326.30
| Professional | | $277.30 | $326.30 | $326.30 |