- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.66 / $222.44 / $1,011.44
| Professional | | $191.66 | $222.44 | $1,011.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.37 / $235.75 / $301.07
| Professional | | $213.37 | $235.75 | $301.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.75 / $270.83 / $505.61
| Professional | | $186.75 | $270.83 | $505.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.44 / $249.54 / $442.30
| Professional | | $193.44 | $249.54 | $442.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.30 / $238.74 / $422.84
| Professional | | $169.30 | $238.74 | $422.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.04 / $222.46 / $275.76
| Professional | | $151.04 | $222.46 | $275.76 |