- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.83 / $305.57 / $305.57
| Professional | | $264.83 | $305.57 | $305.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.94 / $366.69 / $418.03
| Professional | | $325.94 | $366.69 | $418.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.94 / $215.94 / $215.94
| Professional | | $215.94 | $215.94 | $215.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.43 / $488.92 / $611.15
| Professional | | $407.43 | $488.92 | $611.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.12 / $183.34 / $325.76
| Professional | | $171.12 | $183.34 | $325.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.72 / $324.00 / $324.00
| Professional | | $203.72 | $324.00 | $324.00 |