- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.78 / $172.98 / $186.58
| Professional | | $146.78 | $172.98 | $186.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.01 / $153.72 / $234.42
| Professional | | $126.01 | $153.72 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.43 / $196.63 / $260.89
| Professional | | $159.43 | $196.63 | $260.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $146.74 / $228.33
| Professional | | $131.83 | $146.74 | $228.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.78 / $172.98 / $186.58
| Professional | | $146.78 | $172.98 | $186.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.00 / $182.54 / $235.66
| Professional | | $164.00 | $182.54 | $235.66 |