- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.47 / $192.41 / $193.56
| Professional | | $178.47 | $192.41 | $193.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.56 / $200.33 / $228.98
| Professional | | $190.56 | $200.33 | $228.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.87 / $197.93 / $404.75
| Professional | | $150.87 | $197.93 | $404.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.46 / $212.15 / $352.14
| Professional | | $164.46 | $212.15 | $352.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.07 / $184.05 / $314.16
| Professional | | $143.07 | $184.05 | $314.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.63 / $141.63 / $231.15
| Professional | | $141.63 | $141.63 | $231.15 |