- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.78 / $190.61 / $443.53
| Professional | | $134.78 | $190.61 | $443.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.16 / $207.69 / $266.11
| Professional | | $142.16 | $207.69 | $266.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.94 / $217.50 / $238.72
| Professional | | $196.94 | $217.50 | $238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $167.93 / $211.26
| Professional | | $32.34 | $167.93 | $211.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.08 / $193.03 / $221.21
| Professional | | $164.08 | $193.03 | $221.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.38 / $191.74 / $256.74
| Professional | | $138.38 | $191.74 | $256.74 |