- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.37 / $347.50 / $432.36
| Professional | | $184.37 | $347.50 | $432.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.13 / $402.83 / $593.72
| Professional | | $253.13 | $402.83 | $593.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.18 / $449.21 / $862.14
| Professional | | $240.18 | $449.21 | $862.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.64 / $477.33 / $803.63
| Professional | | $271.64 | $477.33 | $803.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.37 / $326.97 / $475.59
| Professional | | $184.37 | $326.97 | $475.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.95 / $627.02 / $798.60
| Professional | | $345.95 | $627.02 | $798.60 |