- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.94 / $326.58 / $512.70
| Professional | | $184.94 | $326.58 | $512.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.20 / $297.64 / $557.04
| Professional | | $165.20 | $297.64 | $557.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.09 / $354.81 / $662.85
| Professional | | $197.09 | $354.81 | $662.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.07 / $363.06 / $654.46
| Professional | | $211.07 | $363.06 | $654.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.67 / $260.23 / $469.22
| Professional | | $35.67 | $260.23 | $469.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.85 / $456.61 / $754.22
| Professional | | $331.85 | $456.61 | $754.22 |