- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.76 / $202.57 / $414.43
| Professional | | $176.76 | $202.57 | $414.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $333.52 / $366.87 / $366.87
| Professional | | $333.52 | $366.87 | $366.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $213.23
| Professional | | $213.23 | $213.23 | $213.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.25 / $362.25 / $362.25
| Professional | | $362.25 | $362.25 | $362.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.31 / $221.62 / $267.14
| Professional | | $200.31 | $221.62 | $267.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.50 / $325.05 / $413.70
| Professional | | $295.50 | $325.05 | $413.70 |