- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $190.55 / $812.83
| Professional | | $131.83 | $190.55 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $1,318.26
| Professional | | $144.54 | $239.88 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $346.74 / $602.56
| Professional | | $218.78 | $346.74 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $229.09 / $354.81
| Professional | | $50.12 | $229.09 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $269.15 / $575.44
| Professional | | $186.21 | $269.15 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $1,318.26
| Professional | | $144.54 | $239.88 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $758.58
| Professional | | $186.21 | $288.40 | $758.58 |