- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.37 / $155.47 / $189.11
| Professional | | $121.37 | $155.47 | $189.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.64 / $293.70 / $1,104.53
| Professional | | $180.64 | $293.70 | $1,104.53 |
- 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
- $148.18 / $296.45 / $399.59
| Professional | | $148.18 | $296.45 | $399.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.90 / $211.59 / $360.12
| Professional | | $35.90 | $211.59 | $360.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.29 / $293.35 / $355.24
| Professional | | $198.29 | $293.35 | $355.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.64 / $254.15 / $340.42
| Professional | | $180.64 | $254.15 | $340.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.22 / $179.55 / $346.98
| Professional | | $149.22 | $179.55 | $346.98 |