- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.88 / $226.01 / $247.11
| Professional | | $195.88 | $226.01 | $247.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.08 / $271.22 / $309.19
| Professional | | $241.08 | $271.22 | $309.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.07 / $223.85 / $1,548.38
| Professional | | $165.07 | $223.85 | $1,548.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.35 / $361.62 / $452.03
| Professional | | $301.35 | $361.62 | $452.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $135.61 / $274.22
| Professional | | $126.57 | $135.61 | $274.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.68 / $239.57 / $239.57
| Professional | | $150.68 | $239.57 | $239.57 |