- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.13 / $187.35 / $248.81
| Professional | | $160.13 | $187.35 | $248.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.84 / $236.62 / $344.91
| Professional | | $182.84 | $236.62 | $344.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.81 / $282.70 / $406.41
| Professional | | $207.81 | $282.70 | $406.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.89 / $270.64 / $445.55
| Professional | | $225.89 | $270.64 | $445.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.13 / $207.06 / $248.81
| Professional | | $160.13 | $207.06 | $248.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.42 / $289.26 / $390.60
| Professional | | $188.42 | $289.26 | $390.60 |