- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $162.18 / $295.12
| Professional | | $123.03 | $162.18 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $263.03 / $363.08
| Professional | | $147.91 | $263.03 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $363.08
| Professional | | $223.87 | $295.12 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $257.04 / $338.84
| Professional | | $199.53 | $257.04 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $263.03 / $346.74
| Professional | | $79.43 | $263.03 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $281.84 / $346.74
| Professional | | $229.09 | $281.84 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $269.15 / $380.19
| Professional | | $158.49 | $269.15 | $380.19 |