- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.85 / $246.21 / $347.82
| Professional | | $164.85 | $246.21 | $347.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.73 / $287.77 / $410.40
| Professional | | $172.73 | $287.77 | $410.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.01 / $401.50 / $774.51
| Professional | | $244.01 | $401.50 | $774.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.85 / $394.87 / $753.99
| Professional | | $215.85 | $394.87 | $753.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.36 / $480.83 / $1,080.41
| Professional | | $309.36 | $480.83 | $1,080.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.93 / $232.50 / $332.94
| Professional | | $153.93 | $232.50 | $332.94 |