- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.69 / $122.43 / $329.62
| Professional | | $101.69 | $122.43 | $329.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.91 / $143.91 / $1,122.40
| Professional | | $143.91 | $143.91 | $1,122.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.82 / $109.63 / $123.34
| Professional | | $91.82 | $109.63 | $123.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.00 / $161.86 / $296.81
| Professional | | $116.00 | $161.86 | $296.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $103.50 / $137.66 / $257.25
| Facility | | $103.50 | $137.66 | $257.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.03 / $149.37 / $1,352.50
| Professional | | $119.03 | $149.37 | $1,352.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.65 / $142.44 / $244.07
| Professional | | $118.65 | $142.44 | $244.07 |