- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.16 / $184.74 / $271.66
| Professional | | $136.16 | $184.74 | $271.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.68 / $268.83 / $359.66
| Professional | | $197.68 | $268.83 | $359.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.14 / $306.06 / $454.84
| Professional | | $196.14 | $306.06 | $454.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.87 / $291.83 / $517.99
| Professional | | $211.87 | $291.83 | $517.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.06 / $184.74 / $274.45
| Professional | | $133.06 | $184.74 | $274.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.40 / $277.73 / $460.04
| Professional | | $182.40 | $277.73 | $460.04 |