- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.47 / $243.56 / $439.35
| Professional | | $155.47 | $243.56 | $439.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.53 / $231.60 / $407.58
| Professional | | $157.53 | $231.60 | $407.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.72 / $300.86 / $553.37
| Professional | | $184.72 | $300.86 | $553.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.08 / $290.54 / $614.29
| Professional | | $187.08 | $290.54 | $614.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.06 / $446.06 / $446.76
| Professional | | $446.06 | $446.06 | $446.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.06 / $329.28 / $573.49
| Professional | | $224.06 | $329.28 | $573.49 |