- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $223.87 / $575.44
| Professional | | $186.21 | $223.87 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $208.93 / $251.19
| Professional | | $87.10 | $208.93 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $263.03 / $501.19
| Professional | | $181.97 | $263.03 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $204.17 / $354.81
| Professional | | $177.83 | $204.17 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $229.09 / $380.19
| Professional | | $158.49 | $229.09 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $275.42
| Professional | | $151.36 | $229.09 | $275.42 |