- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.03 / $237.92 / $848.64
| Professional | | $146.03 | $237.92 | $848.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.84 / $296.13 / $484.36
| Professional | | $154.84 | $296.13 | $484.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.54 / $477.16 / $737.14
| Professional | | $260.54 | $477.16 | $737.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.02 / $513.44 / $1,181.11
| Professional | | $315.02 | $513.44 | $1,181.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.97 / $477.16 / $691.01
| Professional | | $306.97 | $477.16 | $691.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.02 / $520.99 / $669.01
| Professional | | $315.02 | $520.99 | $669.01 |