- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.04 / $283.45 / $400.85
| Professional | | $211.04 | $283.45 | $400.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.21 / $364.83 / $486.83
| Professional | | $221.21 | $364.83 | $486.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.56 / $508.40 / $862.27
| Professional | | $313.56 | $508.40 | $862.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.64 / $486.11 / $891.93
| Professional | | $273.64 | $486.11 | $891.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.32 / $527.32 / $918.06
| Professional | | $373.32 | $527.32 | $918.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.09 / $245.13 / $307.50
| Professional | | $175.09 | $245.13 | $307.50 |