- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $204.17 / $436.52
| Professional | | $114.82 | $204.17 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $331.13 / $575.44
| Professional | | $190.55 | $331.13 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $288.40 / $562.34
| Professional | | $213.80 | $288.40 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $380.19 / $537.03
| Professional | | $213.80 | $380.19 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $323.59 / $575.44
| Professional | | $79.43 | $323.59 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $354.81 / $575.44
| Professional | | $251.19 | $354.81 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $338.84 / $588.84
| Professional | | $190.55 | $338.84 | $588.84 |