- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.24 / $227.51 / $262.81
| Professional | | $213.24 | $227.51 | $262.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.40 / $248.27 / $359.66
| Professional | | $228.40 | $248.27 | $359.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.75 / $324.93 / $593.60
| Professional | | $240.75 | $324.93 | $593.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.83 / $351.19 / $633.53
| Professional | | $291.83 | $351.19 | $633.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.63 / $227.51 / $262.81
| Professional | | $157.63 | $227.51 | $262.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.35 / $346.93 / $418.71
| Professional | | $205.35 | $346.93 | $418.71 |