- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.71 / $123.02 / $161.62
| Professional | | $97.71 | $123.02 | $161.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.50 / $267.55 / $1,032.08
| Professional | | $166.50 | $267.55 | $1,032.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.51 / $109.51 / $109.51
| Professional | | $109.51 | $109.51 | $109.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.52 / $144.07 / $257.81
| Professional | | $107.52 | $144.07 | $257.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.52 / $148.26 / $258.88
| Professional | | $27.52 | $148.26 | $258.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.56 / $260.58 / $333.81
| Professional | | $170.56 | $260.58 | $333.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.09 / $208.62 / $305.92
| Professional | | $169.09 | $208.62 | $305.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.47 / $201.30 / $350.44
| Professional | | $160.47 | $201.30 | $350.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.60 / $101.60 / $120.08
| Professional | | $101.60 | $101.60 | $120.08 |