- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.43 / $381.25 / $484.70
| Professional | | $183.43 | $381.25 | $484.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $213.23
| Professional | | $213.23 | $213.23 | $213.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.40 / $363.84 / $473.29
| Professional | | $213.40 | $363.84 | $473.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.83 / $260.20 / $286.22
| Professional | | $152.83 | $260.20 | $286.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.24 / $231.19 / $288.70
| Professional | | $203.24 | $231.19 | $288.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.20 / $260.20 / $260.20
| Professional | | $260.20 | $260.20 | $260.20 |