- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.18 / $190.40 / $244.43
| Professional | | $142.18 | $190.40 | $244.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.91 / $206.01 / $297.58
| Professional | | $186.91 | $206.01 | $297.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.34 / $234.10 / $332.90
| Professional | | $191.34 | $234.10 | $332.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.41 / $224.63 / $344.60
| Professional | | $174.41 | $224.63 | $344.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.18 / $190.40 / $190.40
| Professional | | $142.18 | $190.40 | $190.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.95 / $226.49 / $310.35
| Professional | | $164.95 | $226.49 | $310.35 |