- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.41 / $265.62 / $529.50
| Professional | | $160.41 | $265.62 | $529.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.98 / $287.88 / $442.08
| Professional | | $193.98 | $287.88 | $442.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.65 / $407.76 / $494.26
| Professional | | $255.65 | $407.76 | $494.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $350.72 / $441.23
| Professional | | $32.34 | $350.72 | $441.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.80 / $371.13 / $530.91
| Professional | | $270.80 | $371.13 | $530.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.36 / $383.24 / $545.38
| Professional | | $270.36 | $383.24 | $545.38 |