- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $147.91 / $257.04
| Professional | | $123.03 | $147.91 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $263.03 / $323.59
| Professional | | $204.17 | $263.03 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $194.98 / $891.25
| Professional | | $141.25 | $194.98 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $295.12 / $309.03
| Professional | | $275.42 | $295.12 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Professional | | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $194.98 / $229.09
| Professional | | $158.49 | $194.98 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $213.80 / $295.12
| Professional | | $141.25 | $213.80 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $275.42 / $275.42
| Professional | | $223.87 | $275.42 | $275.42 |