- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.58 / $144.47 / $375.82
| Professional | | $74.58 | $144.47 | $375.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.66 / $335.74 / $761.26
| Professional | | $158.66 | $335.74 | $761.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.26 / $373.48 / $932.02
| Professional | | $168.26 | $373.48 | $932.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.60 / $368.73 / $811.47
| Professional | | $166.60 | $368.73 | $811.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.36 / $511.00 / $1,646.32
| Professional | | $217.36 | $511.00 | $1,646.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.60 / $409.06 / $805.20
| Professional | | $208.60 | $409.06 | $805.20 |