- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.24 / $284.66 / $332.74
| Professional | | $266.24 | $284.66 | $332.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.06 / $232.44 / $326.68
| Professional | | $193.06 | $232.44 | $326.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.87 / $370.76 / $529.66
| Professional | | $258.87 | $370.76 | $529.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.75 / $387.38 / $598.46
| Professional | | $240.75 | $387.38 | $598.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $179.15 / $248.42
| Professional | | $32.34 | $179.15 | $248.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.70 / $358.74 / $601.86
| Professional | | $277.70 | $358.74 | $601.86 |