- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $147.91 / $239.88
| Professional | | $128.82 | $147.91 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $295.12 / $467.74
| Professional | | $204.17 | $295.12 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $407.38 / $602.56
| Professional | | $263.03 | $407.38 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $338.84 / $512.86
| Professional | | $245.47 | $338.84 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $263.03 / $724.44
| Professional | | $154.88 | $263.03 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $263.03 / $524.81
| Professional | | $154.88 | $263.03 | $524.81 |