- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.55 / $195.26 / $288.08
| Professional | | $146.55 | $195.26 | $288.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.83 / $225.37 / $296.31
| Professional | | $189.83 | $225.37 | $296.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.84 / $257.56 / $398.18
| Professional | | $203.84 | $257.56 | $398.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.50 / $225.06 / $350.19
| Professional | | $192.50 | $225.06 | $350.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.84 / $210.11 / $288.08
| Professional | | $166.84 | $210.11 | $288.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.07 / $285.57 / $364.22
| Professional | | $211.07 | $285.57 | $364.22 |