- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $204.17 / $363.08
| Professional | | $117.49 | $204.17 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $234.42 / $354.81
| Professional | | $144.54 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $229.09 / $354.81
| Professional | | $208.93 | $229.09 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $213.80 / $281.84
| Professional | | $181.97 | $213.80 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $251.19 / $549.54
| Professional | | $186.21 | $251.19 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $257.04 / $323.59
| Professional | | $181.97 | $257.04 | $323.59 |