- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.71 / $213.60 / $281.18
| Professional | | $166.71 | $213.60 | $281.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.09 / $404.04 / $1,521.98
| Professional | | $248.09 | $404.04 | $1,521.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.07 / $152.07 / $152.07
| Professional | | $152.07 | $152.07 | $152.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.29 / $413.11 / $549.14
| Professional | | $204.29 | $413.11 | $549.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.88 / $264.49 / $449.94
| Professional | | $44.88 | $264.49 | $449.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.73 / $404.03 / $489.27
| Professional | | $273.73 | $404.03 | $489.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.09 / $349.05 / $468.86
| Professional | | $248.09 | $349.05 | $468.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.10 / $245.86 / $504.45
| Professional | | $207.10 | $245.86 | $504.45 |