- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.89 / $222.17 / $262.97
| Professional | | $174.89 | $222.17 | $262.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.55 / $260.11 / $391.34
| Professional | | $200.55 | $260.11 | $391.34 |
- 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
- $178.25 / $321.70 / $567.23
| Professional | | $178.25 | $321.70 | $567.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $287.94 / $354.95 / $573.80
| Professional | | $287.94 | $354.95 | $573.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.87 / $281.45 / $358.22
| Professional | | $255.87 | $281.45 | $358.22 |