- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.52 / $294.17 / $461.28
| Professional | | $198.52 | $294.17 | $461.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.41 / $311.13 / $563.38
| Professional | | $175.41 | $311.13 | $563.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.41 / $238.97 / $405.70
| Professional | | $164.41 | $238.97 | $405.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.21 / $206.76 / $355.68
| Professional | | $33.21 | $206.76 | $355.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.63 / $356.96 / $647.38
| Professional | | $277.63 | $356.96 | $647.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.69 / $276.35 / $276.35
| Professional | | $176.69 | $276.35 | $276.35 |