- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.56 / $313.79 / $595.62
| Professional | | $187.56 | $313.79 | $595.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.64 / $380.97 / $717.38
| Professional | | $227.64 | $380.97 | $717.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.31 / $356.81 / $646.58
| Professional | | $212.31 | $356.81 | $646.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.26 / $356.32 / $480.22
| Professional | | $228.26 | $356.32 | $480.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.14 / $307.11 / $480.33
| Professional | | $263.14 | $307.11 | $480.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.92 / $481.27 / $843.37
| Professional | | $338.92 | $481.27 | $843.37 |