- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.37 / $211.80 / $315.47
| Professional | | $157.37 | $211.80 | $315.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.08 / $319.48 / $520.51
| Professional | | $194.08 | $319.48 | $520.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.82 / $410.56 / $689.56
| Professional | | $224.82 | $410.56 | $689.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.15 / $507.89 / $864.84
| Professional | | $253.15 | $507.89 | $864.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.67 / $451.95 / $974.74
| Professional | | $289.67 | $451.95 | $974.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.85 / $219.72 / $263.66
| Professional | | $158.85 | $219.72 | $263.66 |