- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.25 / $202.54 / $213.05
| Professional | | $147.25 | $202.54 | $213.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.79 / $220.69 / $336.99
| Professional | | $170.79 | $220.69 | $336.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.13 / $259.92 / $395.97
| Professional | | $200.13 | $259.92 | $395.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.64 / $251.81 / $386.29
| Professional | | $217.64 | $251.81 | $386.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.25 / $213.05 / $236.53
| Professional | | $147.25 | $213.05 | $236.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.06 / $262.50 / $356.98
| Professional | | $164.06 | $262.50 | $356.98 |