- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $426.58
| Professional | | $144.54 | $186.21 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $229.09 / $331.13
| Professional | | $154.88 | $229.09 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $234.42 / $371.54
| Professional | | $181.97 | $234.42 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $251.19 / $512.86
| Professional | | $190.55 | $251.19 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $213.80 / $478.63
| Professional | | $151.36 | $213.80 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $213.80 / $380.19
| Professional | | $144.54 | $213.80 | $380.19 |