- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.13 / $312.25 / $436.56
| Professional | | $176.13 | $312.25 | $436.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.53 / $252.76 / $379.87
| Professional | | $171.53 | $252.76 | $379.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.51 / $273.74 / $391.06
| Professional | | $174.51 | $273.74 | $391.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.77 / $347.53 / $612.80
| Professional | | $199.77 | $347.53 | $612.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $438.20
| Professional | | $32.34 | $32.34 | $438.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.30 / $438.49 / $670.75
| Professional | | $337.30 | $438.49 | $670.75 |