- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.46 / $189.07 / $266.55
| Professional | | $101.46 | $189.07 | $266.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.97 / $236.67 / $425.58
| Professional | | $131.97 | $236.67 | $425.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.10 / $300.01 / $577.03
| Professional | | $153.10 | $300.01 | $577.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.14 / $371.02 / $709.94
| Professional | | $172.14 | $371.02 | $709.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.08 / $485.34 / $848.99
| Professional | | $276.08 | $485.34 | $848.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.53 / $147.74 / $231.67
| Professional | | $105.53 | $147.74 | $231.67 |