- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.46 / $236.02 / $629.61
| Professional | | $162.46 | $236.02 | $629.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.57 / $266.85 / $373.97
| Professional | | $173.57 | $266.85 | $373.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.52 / $343.71 / $416.62
| Professional | | $253.52 | $343.71 | $416.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $296.02 / $372.43
| Professional | | $32.34 | $296.02 | $372.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.79 / $318.87 / $433.89
| Professional | | $292.79 | $318.87 | $433.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.14 / $283.81 / $451.41
| Professional | | $198.14 | $283.81 | $451.41 |