- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.91 / $281.44 / $281.44
| Professional | | $243.91 | $281.44 | $281.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.20 / $337.73 / $385.01
| Professional | | $300.20 | $337.73 | $385.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.68 / $196.68 / $196.68
| Professional | | $196.68 | $196.68 | $196.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.25 / $450.30 / $562.88
| Professional | | $375.25 | $450.30 | $562.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.61 / $172.62 / $300.02
| Professional | | $157.61 | $172.62 | $300.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.63 / $187.63 / $187.63
| Professional | | $187.63 | $187.63 | $187.63 |