- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $251.19 / $562.34
| Professional | | $138.04 | $251.19 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $354.81 / $676.08
| Professional | | $199.53 | $354.81 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $616.60
| Professional | | $229.09 | $354.81 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $363.08 / $537.03
| Professional | | $204.17 | $363.08 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $338.84 / $630.96
| Professional | | $79.43 | $338.84 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $426.58 / $645.65
| Professional | | $251.19 | $426.58 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $346.74 / $645.65
| Professional | | $194.98 | $346.74 | $645.65 |