- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.63 / $335.25 / $537.38
| Professional | | $171.63 | $335.25 | $537.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.68 / $290.51 / $446.66
| Professional | | $199.68 | $290.51 | $446.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.64 / $413.64 / $501.38
| Professional | | $263.64 | $413.64 | $501.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $356.14 / $402.10
| Professional | | $32.34 | $356.14 | $402.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.29 / $381.57 / $536.42
| Professional | | $279.29 | $381.57 | $536.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.50 / $376.54 / $548.33
| Professional | | $273.50 | $376.54 | $548.33 |