- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.35 / $314.24 / $408.52
| Professional | | $220.35 | $314.24 | $408.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.25 / $289.25 / $454.85
| Professional | | $215.25 | $289.25 | $454.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.23 / $306.20 / $484.61
| Professional | | $241.23 | $306.20 | $484.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.10 / $367.86 / $648.79
| Professional | | $247.10 | $367.86 | $648.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $335.84
| Professional | | $32.34 | $32.34 | $335.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $307.89 / $420.28 / $661.83
| Professional | | $307.89 | $420.28 | $661.83 |