- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.68 / $226.68 / $316.42
| Professional | | $153.68 | $226.68 | $316.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.60 / $298.58 / $385.63
| Professional | | $195.60 | $298.58 | $385.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.78 / $314.74 / $488.04
| Professional | | $199.78 | $314.74 | $488.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.50 / $307.50 / $543.64
| Professional | | $199.50 | $307.50 | $543.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.27 / $226.68 / $316.42
| Professional | | $157.27 | $226.68 | $316.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.16 / $333.52 / $517.47
| Professional | | $215.16 | $333.52 | $517.47 |