- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.85 / $186.24 / $240.64
| Professional | | $152.85 | $186.24 | $240.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.66 / $206.73 / $322.38
| Professional | | $189.66 | $206.73 | $322.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.69 / $254.81 / $461.04
| Professional | | $134.69 | $254.81 | $461.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.14 / $224.64 / $373.52
| Professional | | $174.14 | $224.64 | $373.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.22 / $219.52 / $440.61
| Professional | | $156.22 | $219.52 | $440.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.04 / $200.26 / $242.79
| Professional | | $173.04 | $200.26 | $242.79 |