- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.66 / $238.62 / $339.32
| Professional | | $147.66 | $238.62 | $339.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.28 / $255.81 / $303.51
| Professional | | $131.28 | $255.81 | $303.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.87 / $230.30 / $344.92
| Professional | | $160.87 | $230.30 | $344.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.87 / $217.65 / $217.65
| Professional | | $181.87 | $217.65 | $217.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.93 / $203.38 / $360.13
| Professional | | $129.93 | $203.38 | $360.13 |