- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.35 / $319.61 / $682.57
| Professional | | $155.35 | $319.61 | $682.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.10 / $391.83 / $719.05
| Professional | | $214.10 | $391.83 | $719.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.38 / $405.13 / $798.32
| Professional | | $209.38 | $405.13 | $798.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.89 / $432.71 / $857.07
| Professional | | $232.89 | $432.71 | $857.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.34 / $319.61 / $715.20
| Professional | | $155.34 | $319.61 | $715.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.04 / $531.14 / $841.68
| Professional | | $379.04 | $531.14 | $841.68 |