- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.69 / $323.86 / $485.69
| Professional | | $188.69 | $323.86 | $485.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.39 / $326.50 / $615.86
| Professional | | $181.39 | $326.50 | $615.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.68 / $275.67 / $434.06
| Professional | | $190.68 | $275.67 | $434.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.21 / $246.35 / $414.06
| Professional | | $33.21 | $246.35 | $414.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.20 / $389.40 / $664.58
| Professional | | $293.20 | $389.40 | $664.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.93 / $319.68 / $319.68
| Professional | | $181.93 | $319.68 | $319.68 |