- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $251.19 / $389.05
| Professional | | $144.54 | $251.19 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $275.42 / $398.11
| Professional | | $162.18 | $275.42 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $295.12 / $457.09
| Professional | | $169.82 | $295.12 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $323.59 / $501.19
| Professional | | $199.53 | $323.59 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $239.88 / $446.68
| Professional | | $141.25 | $239.88 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.96 / $257.04 / $457.09
| Professional | | $165.96 | $257.04 | $457.09 |