- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.17 / $262.69 / $440.65
| Professional | | $192.17 | $262.69 | $440.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.30 / $209.80 / $520.57
| Professional | | $51.30 | $209.80 | $520.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.89 / $323.02 / $583.62
| Professional | | $204.89 | $323.02 | $583.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.69 / $340.03 / $516.98
| Professional | | $262.69 | $340.03 | $516.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.13 / $267.87 / $408.74
| Professional | | $32.13 | $267.87 | $408.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.27 / $398.68 / $550.65
| Professional | | $337.27 | $398.68 | $550.65 |