- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.42 / $186.50 / $396.08
| Professional | | $165.42 | $186.50 | $396.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.47 / $205.78 / $383.57
| Professional | | $150.47 | $205.78 | $383.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.33 / $283.27 / $414.53
| Professional | | $207.33 | $283.27 | $414.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.74 / $159.74 / $159.74
| Professional | | $159.74 | $159.74 | $159.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.59 / $187.40 / $292.92
| Professional | | $146.59 | $187.40 | $292.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.10 / $213.86 / $414.53
| Professional | | $162.10 | $213.86 | $414.53 |