- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $218.78 / $602.56
| Professional | | $109.65 | $218.78 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $223.87 / $426.58
| Professional | | $114.82 | $223.87 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $331.13 / $549.54
| Professional | | $199.53 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $478.63 / $1,479.11
| Professional | | $346.74 | $478.63 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $436.52 / $549.54
| Professional | | $234.42 | $436.52 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $331.13 / $426.58
| Professional | | $208.93 | $331.13 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $309.03 / $549.54
| Professional | | $194.98 | $309.03 | $549.54 |