- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.12 / $194.29 / $223.42
| Professional | | $166.12 | $194.29 | $223.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.42 / $260.11 / $395.50
| Professional | | $196.42 | $260.11 | $395.50 |
- 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
- $190.46 / $255.56 / $442.09
| Professional | | $190.46 | $255.56 | $442.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.12 / $194.83 / $232.60
| Professional | | $166.12 | $194.83 | $232.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.68 / $311.27 / $418.08
| Professional | | $216.68 | $311.27 | $418.08 |