- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $269.15 / $588.84
| Professional | | $151.36 | $269.15 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $190.55 / $354.81
| Professional | | $173.78 | $190.55 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $263.03 / $549.54
| Professional | | $169.82 | $263.03 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $316.23 / $416.87
| Professional | | $234.42 | $316.23 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $194.98 / $371.54
| Professional | | $123.03 | $194.98 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $354.81 / $426.58
| Professional | | $147.91 | $354.81 | $426.58 |