- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.41 / $180.48 / $223.37
| Professional | | $162.41 | $180.48 | $223.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.46 / $218.25 / $622.26
| Professional | | $195.46 | $218.25 | $622.26 |
- 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
- $184.50 / $184.50 / $184.50
| Professional | | $184.50 | $184.50 | $184.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.52 / $220.33 / $310.83
| Professional | | $164.52 | $220.33 | $310.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.02 / $261.08 / $387.66
| Professional | | $181.02 | $261.08 | $387.66 |