- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.60 / $182.11 / $211.64
| Professional | | $146.60 | $182.11 | $211.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.05 / $308.86 / $1,575.61
| Professional | | $161.05 | $308.86 | $1,575.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.45 / $399.40 / $673.11
| Professional | | $219.45 | $399.40 | $673.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.46 / $141.33 / $273.97
| Professional | | $104.46 | $141.33 | $273.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.90 / $412.37 / $532.49
| Professional | | $208.90 | $412.37 | $532.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.55 / $367.71 / $1,575.61
| Professional | | $218.55 | $367.71 | $1,575.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.97 / $308.86 / $618.70
| Professional | | $213.97 | $308.86 | $618.70 |