- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $213.80 / $346.74
| Professional | | $128.82 | $213.80 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $213.80 / $363.08
| Professional | | $117.49 | $213.80 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $263.03 / $416.87
| Professional | | $147.91 | $263.03 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $269.15 / $407.38
| Professional | | $128.82 | $269.15 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $257.04 / $602.56
| Professional | | $141.25 | $257.04 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $234.42 / $416.87
| Professional | | $141.25 | $234.42 | $416.87 |