- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.84 / $228.45 / $395.11
| Professional | | $184.84 | $228.45 | $395.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.81 / $310.33 / $434.31
| Professional | | $239.81 | $310.33 | $434.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.53 / $352.04 / $499.31
| Professional | | $244.53 | $352.04 | $499.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.89 / $348.15 / $534.09
| Professional | | $293.89 | $348.15 | $534.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.53 / $284.74 / $442.90
| Professional | | $198.53 | $284.74 | $442.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.63 / $293.89 / $470.00
| Professional | | $189.63 | $293.89 | $470.00 |