- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.80 / $202.40 / $247.98
| Professional | | $148.80 | $202.40 | $247.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.47 / $182.47 / $193.42
| Professional | | $134.47 | $182.47 | $193.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.32 / $247.10 / $475.86
| Professional | | $158.32 | $247.10 | $475.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.37 / $302.33 / $401.15
| Professional | | $234.37 | $302.33 | $401.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.10 / $248.74 / $453.99
| Professional | | $172.10 | $248.74 | $453.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.91 / $269.52 / $332.57
| Professional | | $195.91 | $269.52 | $332.57 |