- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.12 / $224.36 / $239.53
| Professional | | $143.12 | $224.36 | $239.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.04 / $218.73 / $310.86
| Professional | | $137.04 | $218.73 | $310.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.01 / $240.03 / $417.61
| Professional | | $143.01 | $240.03 | $417.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.97 / $244.02 / $379.70
| Professional | | $147.97 | $244.02 | $379.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.12 / $224.36 / $373.09
| Professional | | $143.12 | $224.36 | $373.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.50 / $277.42 / $387.03
| Professional | | $187.50 | $277.42 | $387.03 |