- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $354.81
| Professional | | $147.91 | $208.93 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $446.68 / $776.25
| Professional | | $275.42 | $446.68 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $562.34 / $954.99
| Professional | | $331.13 | $562.34 | $954.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $524.81 / $891.25
| Professional | | $346.74 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $436.52 / $1,258.93
| Professional | | $218.78 | $436.52 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $346.74 / $676.08
| Professional | | $186.21 | $346.74 | $676.08 |