- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.55 / $213.06 / $291.44
| Professional | | $148.55 | $213.06 | $291.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.84 / $267.68 / $376.16
| Professional | | $206.84 | $267.68 | $376.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.79 / $335.15 / $489.77
| Professional | | $215.79 | $335.15 | $489.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.45 / $310.99 / $546.51
| Professional | | $258.45 | $310.99 | $546.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.55 / $194.08 / $291.44
| Professional | | $148.55 | $194.08 | $291.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.71 / $306.69 / $495.41
| Professional | | $193.71 | $306.69 | $495.41 |