- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.20 / $341.13 / $1,047.39
| Professional | | $208.20 | $341.13 | $1,047.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.82 / $270.92 / $433.46
| Professional | | $157.82 | $270.92 | $433.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.77 / $370.14 / $542.88
| Professional | | $191.77 | $370.14 | $542.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $260.14 / $585.34
| Professional | | $32.34 | $260.14 | $585.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.85 / $370.14 / $542.88
| Professional | | $191.85 | $370.14 | $542.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.16 / $448.25 / $848.47
| Professional | | $358.16 | $448.25 | $848.47 |