- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $467.74
| Professional | | $151.36 | $239.88 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $239.88 / $346.74
| Professional | | $151.36 | $239.88 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $316.23 / $524.81
| Professional | | $199.53 | $316.23 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $323.59 / $575.44
| Professional | | $186.21 | $323.59 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $263.03 / $724.44
| Professional | | $165.96 | $263.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $257.04 / $501.19
| Professional | | $162.18 | $257.04 | $501.19 |