- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.80 / $163.80 / $227.46
| Professional | | $130.80 | $163.80 | $227.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.66 / $201.44 / $293.76
| Professional | | $155.66 | $201.44 | $293.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.86 / $255.02 / $372.67
| Professional | | $180.86 | $255.02 | $372.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.73 / $234.80 / $412.63
| Professional | | $193.73 | $234.80 | $412.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.84 / $175.32 / $227.46
| Professional | | $139.84 | $175.32 | $227.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.66 / $239.74 / $373.22
| Professional | | $154.66 | $239.74 | $373.22 |