- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.88 / $160.37 / $218.60
| Professional | | $142.88 | $160.37 | $218.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.77 / $209.35 / $375.57
| Professional | | $147.77 | $209.35 | $375.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.19 / $204.42 / $247.78
| Professional | | $146.19 | $204.42 | $247.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $33.96 / $199.75
| Professional | | $32.34 | $33.96 | $199.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.58 / $186.56 / $265.20
| Professional | | $158.58 | $186.56 | $265.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.82 / $221.28 / $318.60
| Professional | | $150.82 | $221.28 | $318.60 |