- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.53 / $207.52 / $755.52
| Professional | | $146.53 | $207.52 | $755.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.20 / $286.06 / $375.65
| Professional | | $176.20 | $286.06 | $375.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.03 / $262.63 / $332.92
| Professional | | $218.03 | $262.63 | $332.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.42 / $244.90 / $328.44
| Professional | | $202.42 | $244.90 | $328.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.31 / $286.06 / $356.70
| Professional | | $232.31 | $286.06 | $356.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.51 / $295.95 / $362.89
| Professional | | $242.51 | $295.95 | $362.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.49 / $280.13 / $403.69
| Professional | | $197.49 | $280.13 | $403.69 |