- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.88 / $348.63 / $492.36
| Professional | | $210.88 | $348.63 | $492.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.36 / $647.63 / $900.83
| Professional | | $441.36 | $647.63 | $900.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.79 / $409.89 / $973.90
| Professional | | $215.79 | $409.89 | $973.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.87 / $646.37 / $2,178.14
| Professional | | $352.87 | $646.37 | $2,178.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.92 / $643.59 / $833.70
| Professional | | $459.92 | $643.59 | $833.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.18 / $511.84 / $929.34
| Professional | | $322.18 | $511.84 | $929.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.50 / $511.10 / $702.90
| Professional | | $434.50 | $511.10 | $702.90 |