- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.62 / $230.35 / $401.69
| Professional | | $138.62 | $230.35 | $401.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.84 / $169.97 / $198.26
| Professional | | $128.84 | $169.97 | $198.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.85 / $260.50 / $488.81
| Professional | | $145.85 | $260.50 | $488.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.51 / $307.33 / $551.05
| Professional | | $202.51 | $307.33 | $551.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.54 / $275.32 / $482.02
| Professional | | $203.54 | $275.32 | $482.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.75 / $273.99 / $337.94
| Professional | | $204.75 | $273.99 | $337.94 |