- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.56 / $175.81 / $257.39
| Professional | | $158.56 | $175.81 | $257.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.41 / $201.86 / $283.13
| Professional | | $158.41 | $201.86 | $283.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.07 / $152.07 / $152.07
| Professional | | $152.07 | $152.07 | $152.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.91 / $234.44 / $240.50
| Professional | | $167.91 | $234.44 | $240.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.44 / $311.55 / $409.99
| Professional | | $247.44 | $311.55 | $409.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.18 / $241.21 / $746.87
| Professional | | $182.18 | $241.21 | $746.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.12 / $218.41 / $392.95
| Professional | | $110.12 | $218.41 | $392.95 |