- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.74 / $157.59 / $157.59
| Professional | | $144.74 | $157.59 | $157.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.20 / $299.48 / $369.01
| Professional | | $295.20 | $299.48 | $369.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.63 / $234.04 / $377.73
| Professional | | $133.63 | $234.04 | $377.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.75 / $312.32 / $408.73
| Professional | | $257.75 | $312.32 | $408.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.55 / $255.06 / $317.95
| Professional | | $189.55 | $255.06 | $317.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.92 / $234.04 / $359.74
| Professional | | $165.92 | $234.04 | $359.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.10 / $320.10 / $320.10
| Professional | | $320.10 | $320.10 | $320.10 |