- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.48 / $277.14 / $329.09
| Professional | | $192.48 | $277.14 | $329.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.08 / $296.16 / $357.14
| Professional | | $229.08 | $296.16 | $357.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.20 / $329.94 / $466.89
| Professional | | $272.20 | $329.94 | $466.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $110.64 / $303.17
| Professional | | $32.34 | $110.64 | $303.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.07 / $429.49 / $473.52
| Professional | | $365.07 | $429.49 | $473.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.04 / $204.82 / $366.51
| Professional | | $164.04 | $204.82 | $366.51 |