- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.54 / $323.86 / $475.59
| Professional | | $215.54 | $323.86 | $475.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.27 / $235.86 / $299.54
| Professional | | $212.27 | $235.86 | $299.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.22 / $367.44 / $718.40
| Professional | | $207.22 | $367.44 | $718.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.39 / $461.83 / $946.84
| Professional | | $341.39 | $461.83 | $946.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.70 / $441.94 / $814.97
| Professional | | $339.70 | $441.94 | $814.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.79 / $368.52 / $461.83
| Professional | | $244.79 | $368.52 | $461.83 |