- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.48 / $310.36 / $498.71
| Professional | | $183.48 | $310.36 | $498.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.13 / $217.13 / $259.33
| Professional | | $217.13 | $217.13 | $259.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.23 / $346.40 / $717.13
| Professional | | $199.23 | $346.40 | $717.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.69 / $453.68 / $612.45
| Professional | | $351.69 | $453.68 | $612.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.70 / $359.97 / $711.45
| Professional | | $267.70 | $359.97 | $711.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.20 / $404.44 / $498.30
| Professional | | $316.20 | $404.44 | $498.30 |