- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.94 / $143.51 / $242.26
| Professional | | $46.94 | $143.51 | $242.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.78 / $354.47 / $1,238.25
| Professional | | $188.78 | $354.47 | $1,238.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.46 / $239.40 / $467.41
| Professional | | $94.46 | $239.40 | $467.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.12 / $230.46 / $388.85
| Professional | | $95.12 | $230.46 | $388.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.51 / $187.85 / $335.43
| Professional | | $32.51 | $187.85 | $335.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.01 / $336.58 / $430.23
| Professional | | $212.01 | $336.58 | $430.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.00 / $296.18 / $378.99
| Professional | | $214.00 | $296.18 | $378.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.63 / $236.38 / $434.85
| Professional | | $151.63 | $236.38 | $434.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.35 / $153.35 / $153.35
| Professional | | $153.35 | $153.35 | $153.35 |