- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.61 / $131.52 / $236.50
| Professional | | $103.61 | $131.52 | $236.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.86 / $333.69 / $506.78
| Professional | | $201.86 | $333.69 | $506.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.87 / $437.13 / $621.35
| Professional | | $253.87 | $437.13 | $621.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.24 / $357.81 / $573.38
| Professional | | $222.24 | $357.81 | $573.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.38 / $370.39 / $571.09
| Professional | | $188.38 | $370.39 | $571.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.25 / $352.38 / $571.09
| Professional | | $191.25 | $352.38 | $571.09 |