- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.94 / $210.05 / $368.71
| Professional | | $137.94 | $210.05 | $368.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.19 / $226.11 / $325.68
| Professional | | $192.19 | $226.11 | $325.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.53 / $343.07 / $588.58
| Professional | | $205.53 | $343.07 | $588.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.70 / $372.22 / $597.55
| Professional | | $212.70 | $372.22 | $597.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.94 / $210.05 / $368.71
| Professional | | $137.94 | $210.05 | $368.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.17 / $338.37 / $554.79
| Professional | | $234.17 | $338.37 | $554.79 |