- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.88 / $198.28 / $306.76
| Professional | | $148.88 | $198.28 | $306.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.38 / $211.04 / $306.74
| Professional | | $179.38 | $211.04 | $306.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.05 / $307.08 / $502.28
| Professional | | $193.05 | $307.08 | $502.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.33 / $323.16 / $545.90
| Professional | | $200.33 | $323.16 | $545.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.19 / $198.28 / $306.76
| Professional | | $157.19 | $198.28 | $306.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.60 / $324.22 / $515.53
| Professional | | $208.60 | $324.22 | $515.53 |