- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.50 / $224.68 / $271.79
| Professional | | $136.50 | $224.68 | $271.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.01 / $191.93 / $277.22
| Professional | | $157.01 | $191.93 | $277.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.07 / $302.26 / $516.50
| Professional | | $181.07 | $302.26 | $516.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.31 / $283.18 / $440.63
| Professional | | $179.31 | $283.18 | $440.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.50 / $224.68 / $432.64
| Professional | | $136.50 | $224.68 | $432.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.77 / $321.25 / $475.18
| Professional | | $202.77 | $321.25 | $475.18 |