- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.72 / $332.28 / $336.19
| Professional | | $274.72 | $332.28 | $336.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.36 / $378.64 / $434.85
| Professional | | $184.36 | $378.64 | $434.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.61 / $436.16 / $736.18
| Professional | | $287.61 | $436.16 | $736.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.74 / $371.18 / $641.41
| Professional | | $287.74 | $371.18 | $641.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.70 / $433.82 / $741.84
| Professional | | $218.70 | $433.82 | $741.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.59 / $340.59 / $340.59
| Professional | | $340.59 | $340.59 | $340.59 |