- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.28 / $152.33 / $237.12
| Professional | | $121.28 | $152.33 | $237.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.13 / $105.13 / $105.13
| Professional | | $105.13 | $105.13 | $105.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.70 / $253.37 / $334.78
| Professional | | $193.70 | $253.37 | $334.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.68 / $208.68 / $208.68
| Professional | | $208.68 | $208.68 | $208.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.13 / $212.90 / $489.88
| Professional | | $143.13 | $212.90 | $489.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.62 / $167.73 / $239.78
| Professional | | $126.62 | $167.73 | $239.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.29 / $152.68 / $288.06
| Professional | | $108.29 | $152.68 | $288.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.72 / $193.72 / $193.72
| Professional | | $193.72 | $193.72 | $193.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.47 / $200.61 / $422.33
| Professional | | $137.47 | $200.61 | $422.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.37 / $173.36 / $362.63
| Professional | | $119.37 | $173.36 | $362.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.47 / $137.02 / $288.06
| Professional | | $116.47 | $137.02 | $288.06 |