- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.11 / $240.33 / $321.85
| Professional | | $154.11 | $240.33 | $321.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.66 / $216.07 / $310.94
| Professional | | $183.66 | $216.07 | $310.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.53 / $314.52 / $490.85
| Professional | | $197.53 | $314.52 | $490.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.80 / $312.86 / $552.63
| Professional | | $202.80 | $312.86 | $552.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.62 / $205.19 / $321.85
| Professional | | $141.62 | $205.19 | $321.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.92 / $336.29 / $516.85
| Professional | | $207.92 | $336.29 | $516.85 |