- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.46 / $244.55 / $420.46
| Professional | | $155.46 | $244.55 | $420.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.71 / $213.78 / $303.93
| Professional | | $181.71 | $213.78 | $303.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.69 / $319.63 / $502.24
| Professional | | $195.69 | $319.63 | $502.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.44 / $314.92 / $538.02
| Professional | | $197.44 | $314.92 | $538.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.01 / $259.70 / $439.35
| Professional | | $169.01 | $259.70 | $439.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.58 / $337.25 / $522.29
| Professional | | $223.58 | $337.25 | $522.29 |