- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $257.04 / $724.44
| Professional | | $151.36 | $257.04 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $251.19 / $416.87
| Professional | | $190.55 | $251.19 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $524.81
| Professional | | $190.55 | $309.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $295.12 / $478.63
| Professional | | $186.21 | $295.12 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $151.36
| Professional | | $32.36 | $33.11 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $295.12 / $478.63
| Professional | | $177.83 | $295.12 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $251.19 / $426.58
| Professional | | $165.96 | $251.19 | $426.58 |