- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.59 / $154.38 / $414.11
| Professional | | $99.59 | $154.38 | $414.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.09 / $266.69 / $422.67
| Professional | | $155.09 | $266.69 | $422.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $233.19 / $292.31 / $382.62
| Professional | | $233.19 | $292.31 | $382.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.70 / $252.98 / $360.73
| Professional | | $182.70 | $252.98 | $360.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.75 / $288.83 / $404.09
| Professional | | $204.75 | $288.83 | $404.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.19 / $301.04 / $430.59
| Professional | | $204.19 | $301.04 | $430.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.24 / $314.30 / $490.12
| Professional | | $219.24 | $314.30 | $490.12 |