- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $229.09 / $407.38
| Professional | | $147.91 | $229.09 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $263.03 / $457.09
| Professional | | $154.88 | $263.03 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $204.17 / $275.42
| Professional | | $131.83 | $204.17 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $125.89 / $354.81
| Professional | | $32.36 | $125.89 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $213.80 / $398.11
| Professional | | $131.83 | $213.80 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $199.53 / $269.15
| Professional | | $125.89 | $199.53 | $269.15 |