- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $316.23 / $660.69
| Professional | | $186.21 | $316.23 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $331.13 / $467.74
| Professional | | $218.78 | $331.13 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $398.11 / $645.65
| Professional | | $257.04 | $398.11 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $478.63 / $851.14
| Professional | | $269.15 | $478.63 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $371.54 / $831.76
| Professional | | $208.93 | $371.54 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $323.59 / $724.44
| Professional | | $204.17 | $323.59 | $724.44 |