- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.97 / $167.28 / $225.94
| Professional | | $146.97 | $167.28 | $225.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.19 / $187.45 / $264.72
| Professional | | $168.19 | $187.45 | $264.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.16 / $193.33 / $306.36
| Professional | | $148.16 | $193.33 | $306.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.66 / $253.66 / $253.66
| Professional | | $253.66 | $253.66 | $253.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.63 / $178.44 / $330.18
| Professional | | $136.63 | $178.44 | $330.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.97 / $172.88 / $225.94
| Professional | | $146.97 | $172.88 | $225.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.76 / $181.63 / $264.70
| Professional | | $129.76 | $181.63 | $264.70 |