- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.71 / $252.29 / $318.23
| Professional | | $189.71 | $252.29 | $318.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.47 / $181.94 / $301.02
| Professional | | $136.47 | $181.94 | $301.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.45 / $288.54 / $412.20
| Professional | | $187.45 | $288.54 | $412.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.06 / $391.01 / $632.16
| Professional | | $243.06 | $391.01 | $632.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $126.25 / $305.98
| Professional | | $32.34 | $126.25 | $305.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.89 / $410.64 / $638.66
| Professional | | $306.89 | $410.64 | $638.66 |