- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.87 / $212.16 / $212.16
| Professional | | $183.87 | $212.16 | $212.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.30 / $254.59 / $290.23
| Professional | | $226.30 | $254.59 | $290.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.27 / $148.27 / $148.27
| Professional | | $148.27 | $148.27 | $148.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.88 / $339.46 / $424.32
| Professional | | $282.88 | $339.46 | $424.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.81 / $130.12 / $226.17
| Professional | | $118.81 | $130.12 | $226.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.44 / $141.44 / $141.44
| Professional | | $141.44 | $141.44 | $141.44 |