- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.50 / $145.02 / $230.34
| Professional | | $115.50 | $145.02 | $230.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.00 / $265.64 / $409.96
| Professional | | $155.00 | $265.64 | $409.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.54 / $305.25 / $517.92
| Professional | | $186.54 | $305.25 | $517.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.66 / $298.83 / $517.60
| Professional | | $177.66 | $298.83 | $517.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.50 / $121.20 / $230.34
| Professional | | $115.50 | $121.20 | $230.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.83 / $379.77 / $550.02
| Professional | | $272.83 | $379.77 | $550.02 |