- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.01 / $135.69 / $237.98
| Professional | | $99.01 | $135.69 | $237.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.17 / $329.78 / $512.64
| Professional | | $197.17 | $329.78 | $512.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $248.85 / $425.34 / $635.76
| Professional | | $248.85 | $425.34 | $635.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.41 / $357.75 / $588.25
| Professional | | $219.41 | $357.75 | $588.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.68 / $377.41 / $802.40
| Professional | | $186.68 | $377.41 | $802.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.34 / $355.16 / $533.53
| Professional | | $173.34 | $355.16 | $533.53 |