- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.76 / $262.12 / $376.87
| Professional | | $219.76 | $262.12 | $376.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.35 / $366.46 / $550.41
| Professional | | $243.35 | $366.46 | $550.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.63 / $439.71 / $826.11
| Professional | | $261.63 | $439.71 | $826.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.99 / $463.90 / $934.48
| Professional | | $238.99 | $463.90 | $934.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.37 / $486.64 / $912.70
| Professional | | $290.37 | $486.64 | $912.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.85 / $252.65 / $353.71
| Professional | | $178.85 | $252.65 | $353.71 |