- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.19 / $195.48 / $272.64
| Professional | | $139.19 | $195.48 | $272.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.68 / $259.82 / $371.86
| Professional | | $190.68 | $259.82 | $371.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.15 / $301.02 / $484.99
| Professional | | $188.15 | $301.02 | $484.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.87 / $304.75 / $507.99
| Professional | | $211.87 | $304.75 | $507.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.19 / $195.48 / $281.92
| Professional | | $139.19 | $195.48 | $281.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.10 / $336.14 / $494.52
| Professional | | $199.10 | $336.14 | $494.52 |