- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.38 / $187.40 / $212.79
| Professional | | $144.38 | $187.40 | $212.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.94 / $238.04 / $352.57
| Professional | | $183.94 | $238.04 | $352.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.03 / $275.16 / $383.27
| Professional | | $194.03 | $275.16 | $383.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.76 / $256.58 / $393.60
| Professional | | $221.76 | $256.58 | $393.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.38 / $212.79 / $274.33
| Professional | | $144.38 | $212.79 | $274.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.80 / $215.54 / $285.22
| Professional | | $163.80 | $215.54 | $285.22 |