- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.66 / $208.10 / $510.43
| Professional | | $124.66 | $208.10 | $510.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.41 / $254.26 / $367.51
| Professional | | $142.41 | $254.26 | $367.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.22 / $392.11 / $651.57
| Professional | | $209.22 | $392.11 | $651.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.53 / $399.74 / $785.21
| Professional | | $183.53 | $399.74 | $785.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.60 / $405.87 / $705.78
| Professional | | $315.60 | $405.87 | $705.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.63 / $185.09 / $259.13
| Professional | | $122.63 | $185.09 | $259.13 |