- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.44 / $200.91 / $447.91
| Professional | | $156.44 | $200.91 | $447.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.99 / $392.23 / $2,295.00
| Professional | | $224.99 | $392.23 | $2,295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.87 / $311.81 / $487.07
| Professional | | $169.87 | $311.81 | $487.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.84 / $299.52 / $446.73
| Professional | | $163.84 | $299.52 | $446.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.82 / $218.82 / $371.25
| Professional | | $36.82 | $218.82 | $371.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.34 / $360.38 / $445.54
| Professional | | $230.34 | $360.38 | $445.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.99 / $311.81 / $414.41
| Professional | | $224.99 | $311.81 | $414.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.59 / $283.79 / $461.76
| Professional | | $173.59 | $283.79 | $461.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.13 / $174.08 / $174.08
| Professional | | $123.13 | $174.08 | $174.08 |