- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.80 / $220.53 / $471.57
| Professional | | $148.80 | $220.53 | $471.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.31 / $320.64 / $443.05
| Professional | | $167.31 | $320.64 | $443.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.73 / $329.02 / $531.54
| Professional | | $226.73 | $329.02 | $531.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.46 / $293.44 / $391.48
| Professional | | $193.46 | $293.44 | $391.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.48 / $373.64 / $641.51
| Professional | | $196.48 | $373.64 | $641.51 |