- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.77 / $237.48 / $618.91
| Professional | | $120.77 | $237.48 | $618.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.81 / $315.38 / $618.39
| Professional | | $178.81 | $315.38 | $618.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.29 / $333.95 / $566.54
| Professional | | $227.29 | $333.95 | $566.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.90 / $344.40 / $538.26
| Professional | | $198.90 | $344.40 | $538.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.26 / $351.82 / $601.69
| Professional | | $222.26 | $351.82 | $601.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.05 / $380.79 / $636.24
| Professional | | $225.05 | $380.79 | $636.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.20 / $436.25 / $762.03
| Professional | | $316.20 | $436.25 | $762.03 |