- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.40 / $277.95 / $355.02
| Professional | | $193.40 | $277.95 | $355.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.51 / $239.35 / $392.20
| Professional | | $161.51 | $239.35 | $392.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.78 / $268.29 / $416.32
| Professional | | $212.78 | $268.29 | $416.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.54 / $334.44 / $612.17
| Professional | | $210.54 | $334.44 | $612.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.93 / $380.97 / $653.71
| Professional | | $304.93 | $380.97 | $653.71 |