- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $239.88 / $524.81
| Professional | | $147.91 | $239.88 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $173.78 / $213.80
| Professional | | $141.25 | $173.78 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $263.03 / $524.81
| Professional | | $158.49 | $263.03 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $316.23 / $478.63
| Professional | | $263.03 | $316.23 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $239.88 / $446.68
| Professional | | $141.25 | $239.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $331.13 / $416.87
| Professional | | $151.36 | $331.13 | $416.87 |