- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.55 / $235.43 / $305.58
| Professional | | $151.55 | $235.43 | $305.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.33 / $186.98 / $205.77
| Professional | | $185.33 | $186.98 | $205.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.85 / $268.16 / $547.52
| Professional | | $162.85 | $268.16 | $547.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.41 / $346.25 / $462.86
| Professional | | $268.41 | $346.25 | $462.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.19 / $289.64 / $519.83
| Professional | | $198.19 | $289.64 | $519.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.68 / $308.67 / $381.03
| Professional | | $227.68 | $308.67 | $381.03 |