- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.44 / $261.62 / $423.43
| Professional | | $203.44 | $261.62 | $423.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.99 / $331.28 / $465.11
| Professional | | $255.99 | $331.28 | $465.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.94 / $397.98 / $553.50
| Professional | | $275.94 | $397.98 | $553.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.69 / $384.22 / $618.94
| Professional | | $320.69 | $384.22 | $618.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.46 / $264.17 / $438.92
| Professional | | $220.46 | $264.17 | $438.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.00 / $358.72 / $560.91
| Professional | | $234.00 | $358.72 | $560.91 |