- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.22 / $274.99 / $1,602.51
| Professional | | $85.22 | $274.99 | $1,602.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.47 / $320.83 / $836.70
| Professional | | $160.47 | $320.83 | $836.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.99 / $288.18 / $753.70
| Professional | | $166.99 | $288.18 | $753.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.97 / $441.05 / $964.42
| Professional | | $141.97 | $441.05 | $964.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.85 / $391.22 / $820.83
| Professional | | $176.85 | $391.22 | $820.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.62 / $301.88 / $843.28
| Professional | | $169.62 | $301.88 | $843.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.02 / $698.44 / $938.07
| Professional | | $453.02 | $698.44 | $938.07 |