- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.88 / $174.89 / $341.75
| Professional | | $135.88 | $174.89 | $341.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.72 / $404.86 / $581.86
| Professional | | $264.72 | $404.86 | $581.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.14 / $314.52 / $480.75
| Professional | | $250.14 | $314.52 | $480.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.66 / $247.66 / $449.20
| Professional | | $247.66 | $247.66 | $449.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.94 / $330.44 / $647.37
| Professional | | $201.94 | $330.44 | $647.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.13 / $323.85 / $553.45
| Professional | | $198.13 | $323.85 | $553.45 |