- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.56 / $50.05 / $449.60
| Professional | | $35.56 | $50.05 | $449.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.79 / $248.55 / $1,219.48
| Professional | | $48.79 | $248.55 | $1,219.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.90 / $480.19 / $915.38
| Professional | | $146.90 | $480.19 | $915.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.19 / $254.05 / $421.50
| Professional | | $148.19 | $254.05 | $421.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.76 / $520.87 / $777.65
| Professional | | $252.76 | $520.87 | $777.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.33 / $78.67 / $1,246.66
| Professional | | $46.33 | $78.67 | $1,246.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.86 / $67.89 / $644.94
| Professional | | $44.86 | $67.89 | $644.94 |