- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.73 / $246.46 / $903.87
| Professional | | $165.73 | $246.46 | $903.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.67 / $332.05 / $1,308.32
| Professional | | $192.67 | $332.05 | $1,308.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.88 / $599.87 / $722.26
| Professional | | $416.88 | $599.87 | $722.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.50 / $249.50 / $451.90
| Professional | | $171.50 | $249.50 | $451.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.65 / $201.25 / $362.36
| Professional | | $38.65 | $201.25 | $362.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.05 / $196.05 / $196.05
| Professional | | $196.05 | $196.05 | $196.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.90 / $275.25 / $370.24
| Professional | | $207.90 | $275.25 | $370.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.07 / $287.25 / $448.32
| Professional | | $187.07 | $287.25 | $448.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.68 / $161.68 / $199.00
| Professional | | $161.68 | $161.68 | $199.00 |