- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.24 / $152.84 / $480.57
| Professional | | $86.24 | $152.84 | $480.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.40 / $236.38 / $472.12
| Professional | | $137.40 | $236.38 | $472.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.24 / $251.25 / $426.27
| Professional | | $172.24 | $251.25 | $426.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.57 / $240.12 / $428.07
| Professional | | $149.57 | $240.12 | $428.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.15 / $264.33 / $459.08
| Professional | | $172.15 | $264.33 | $459.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.86 / $284.27 / $486.74
| Professional | | $172.86 | $284.27 | $486.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.40 / $308.20 / $554.27
| Professional | | $225.40 | $308.20 | $554.27 |