- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.50 / $154.38 / $179.75
| Professional | | $142.50 | $154.38 | $179.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.29 / $216.63 / $310.39
| Professional | | $157.29 | $216.63 | $310.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.23 / $281.06 / $402.80
| Professional | | $179.23 | $281.06 | $402.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.60 / $251.85 / $391.88
| Professional | | $182.60 | $251.85 | $391.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.50 / $154.38 / $234.56
| Professional | | $142.50 | $154.38 | $234.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.47 / $258.83 / $418.57
| Professional | | $179.47 | $258.83 | $418.57 |