- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.23 / $401.06 / $549.51
| Professional | | $214.23 | $401.06 | $549.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.52 / $190.02 / $266.41
| Professional | | $161.52 | $190.02 | $266.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.10 / $357.07 / $572.20
| Professional | | $198.10 | $357.07 | $572.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.54 / $300.49 / $482.41
| Professional | | $173.54 | $300.49 | $482.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.23 / $407.22 / $549.51
| Professional | | $214.23 | $407.22 | $549.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $386.03 / $601.27 / $751.59
| Professional | | $386.03 | $601.27 | $751.59 |