- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.76 / $246.64 / $428.01
| Professional | | $157.76 | $246.64 | $428.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.32 / $297.29 / $532.04
| Professional | | $197.32 | $297.29 | $532.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.15 / $308.26 / $608.37
| Professional | | $200.15 | $308.26 | $608.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.75 / $309.82 / $485.62
| Professional | | $203.75 | $309.82 | $485.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.94 / $420.94 / $425.29
| Professional | | $420.94 | $420.94 | $425.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.68 / $351.64 / $648.24
| Professional | | $243.68 | $351.64 | $648.24 |