- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.54 / $165.52 / $462.52
| Professional | | $151.54 | $165.52 | $462.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.77 / $342.37 / $491.80
| Professional | | $255.77 | $342.37 | $491.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.02 / $336.45 / $418.71
| Professional | | $271.02 | $336.45 | $418.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.85 / $300.82 / $530.47
| Professional | | $266.85 | $300.82 | $530.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.93 / $332.17 / $485.45
| Professional | | $294.93 | $332.17 | $485.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.81 / $364.09 / $546.76
| Professional | | $324.81 | $364.09 | $546.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.70 / $316.56 / $503.37
| Professional | | $219.70 | $316.56 | $503.37 |