- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.71 / $244.55 / $328.80
| Professional | | $153.71 | $244.55 | $328.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.94 / $258.13 / $379.96
| Professional | | $154.94 | $258.13 | $379.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.10 / $372.60 / $724.53
| Professional | | $223.10 | $372.60 | $724.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.62 / $362.28 / $702.49
| Professional | | $193.62 | $362.28 | $702.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $273.79 / $395.19 / $763.36
| Professional | | $273.79 | $395.19 | $763.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.81 / $177.53 / $248.86
| Professional | | $126.81 | $177.53 | $248.86 |