- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.02 / $207.54 / $283.02
| Professional | | $154.02 | $207.54 | $283.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.50 / $184.50 / $184.50
| Professional | | $184.50 | $184.50 | $184.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.94 / $397.03 / $491.25
| Professional | | $282.94 | $397.03 | $491.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.62 / $356.42 / $657.80
| Professional | | $224.62 | $356.42 | $657.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.50 / $267.12 / $498.33
| Professional | | $184.50 | $267.12 | $498.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.45 / $352.83 / $544.72
| Professional | | $309.45 | $352.83 | $544.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.97 / $422.78 / $652.41
| Professional | | $305.97 | $422.78 | $652.41 |