- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.72 / $350.65 / $691.60
| Professional | | $236.72 | $350.65 | $691.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.56 / $385.13 / $628.83
| Professional | | $184.56 | $385.13 | $628.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.03 / $421.11 / $783.71
| Professional | | $187.03 | $421.11 | $783.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.63 / $369.11 / $604.79
| Professional | | $222.63 | $369.11 | $604.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.36 / $427.00 / $911.07
| Professional | | $290.36 | $427.00 | $911.07 |