- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.03 / $349.66 / $403.15
| Professional | | $102.03 | $349.66 | $403.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.68 / $196.91 / $308.93
| Professional | | $135.68 | $196.91 | $308.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.95 / $246.95 / $267.94
| Professional | | $246.95 | $246.95 | $267.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.37 / $153.28 / $276.49
| Professional | | $127.37 | $153.28 | $276.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.58 / $337.35 / $396.88
| Professional | | $325.58 | $337.35 | $396.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.52 / $63.31 / $386.66
| Professional | | $46.52 | $63.31 | $386.66 |