- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.27 / $225.11 / $334.52
| Professional | | $139.27 | $225.11 | $334.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.61 / $210.13 / $298.85
| Professional | | $178.61 | $210.13 | $298.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.24 / $311.27 / $521.77
| Professional | | $192.24 | $311.27 | $521.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.15 / $327.29 / $529.05
| Professional | | $194.15 | $327.29 | $529.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.27 / $225.11 / $334.52
| Professional | | $139.27 | $225.11 | $334.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.48 / $362.79 / $543.30
| Professional | | $227.48 | $362.79 | $543.30 |