- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.37 / $147.57 / $235.01
| Professional | | $119.37 | $147.57 | $235.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.05 / $165.36 / $251.17
| Professional | | $138.05 | $165.36 | $251.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.97 / $209.90 / $331.06
| Professional | | $159.97 | $209.90 | $331.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.41 / $196.62 / $305.94
| Professional | | $162.41 | $196.62 | $305.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.37 / $157.15 / $243.97
| Professional | | $119.37 | $157.15 | $243.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.41 / $214.86 / $310.26
| Professional | | $162.41 | $214.86 | $310.26 |