- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.60 / $207.78 / $298.43
| Professional | | $135.60 | $207.78 | $298.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.34 / $271.02 / $394.65
| Professional | | $172.34 | $271.02 | $394.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.90 / $301.64 / $548.62
| Professional | | $177.90 | $301.64 | $548.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.25 / $314.60 / $552.30
| Professional | | $177.25 | $314.60 | $552.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.40 / $224.44 / $344.00
| Professional | | $136.40 | $224.44 | $344.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.92 / $348.80 / $533.28
| Professional | | $231.92 | $348.80 | $533.28 |