- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.44 / $311.93 / $389.15
| Professional | | $227.44 | $311.93 | $389.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.93 / $286.80 / $423.12
| Professional | | $198.93 | $286.80 | $423.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.11 / $327.93 / $1,013.00
| Professional | | $216.11 | $327.93 | $1,013.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.85 / $359.33 / $641.67
| Professional | | $228.85 | $359.33 | $641.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.22 / $341.06 / $420.65
| Professional | | $284.22 | $341.06 | $420.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.00 / $471.00 / $695.00
| Professional | | $389.00 | $471.00 | $695.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.66 / $442.18 / $982.00
| Professional | | $284.66 | $442.18 | $982.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.22 / $411.83 / $774.59
| Professional | | $246.22 | $411.83 | $774.59 |