- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.91 / $283.39 / $317.27
| Professional | | $188.91 | $283.39 | $317.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.64 / $301.58 / $400.89
| Professional | | $207.64 | $301.58 | $400.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.02 / $339.09 / $589.97
| Professional | | $214.02 | $339.09 | $589.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.86 / $314.51 / $489.38
| Professional | | $204.86 | $314.51 | $489.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.25 / $280.00 / $317.27
| Professional | | $185.25 | $280.00 | $317.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.48 / $388.75 / $530.87
| Professional | | $276.48 | $388.75 | $530.87 |