- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.94 / $178.13 / $256.52
| Professional | | $142.94 | $178.13 | $256.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.26 / $222.92 / $308.82
| Professional | | $172.26 | $222.92 | $308.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.79 / $300.82 / $439.60
| Professional | | $193.79 | $300.82 | $439.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.82 / $275.76 / $489.45
| Professional | | $216.82 | $275.76 | $489.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.13 / $177.47 / $256.52
| Professional | | $137.13 | $177.47 | $256.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.72 / $256.86 / $447.19
| Professional | | $165.72 | $256.86 | $447.19 |