- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.30 / $198.91 / $326.38
| Professional | | $149.30 | $198.91 | $326.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.22 / $209.67 / $296.94
| Professional | | $178.22 | $209.67 | $296.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.53 / $324.20 / $504.66
| Professional | | $192.53 | $324.20 | $504.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.73 / $314.92 / $527.91
| Professional | | $193.73 | $314.92 | $527.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.56 / $198.91 / $326.38
| Professional | | $138.56 | $198.91 | $326.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.61 / $332.85 / $522.20
| Professional | | $220.61 | $332.85 | $522.20 |