- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.36 / $306.83 / $425.72
| Professional | | $220.36 | $306.83 | $425.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.15 / $369.29 / $620.30
| Professional | | $232.15 | $369.29 | $620.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.24 / $259.88 / $391.60
| Professional | | $149.24 | $259.88 | $391.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.88 / $290.73 / $439.58
| Professional | | $33.88 | $290.73 | $439.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.54 / $363.93 / $622.76
| Professional | | $265.54 | $363.93 | $622.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.54 / $262.47 / $262.47
| Professional | | $181.54 | $262.47 | $262.47 |