- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $389.05
| Professional | | $144.54 | $223.87 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $251.19 / $501.19
| Professional | | $147.91 | $251.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $169.82 / $229.09
| Professional | | $158.49 | $169.82 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $269.15
| Professional | | $32.36 | $33.11 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $245.47 / $457.09
| Professional | | $144.54 | $245.47 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $173.78 / $229.09
| Professional | | $114.82 | $173.78 | $229.09 |