- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.93 / $184.69 / $223.61
| Professional | | $161.93 | $184.69 | $223.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.87 / $184.40 / $262.02
| Professional | | $164.87 | $184.40 | $262.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.21 / $199.75 / $300.51
| Professional | | $145.21 | $199.75 | $300.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.41 / $175.55 / $324.82
| Professional | | $134.41 | $175.55 | $324.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.53 / $184.69 / $230.43
| Professional | | $146.53 | $184.69 | $230.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.31 / $192.44 / $260.64
| Professional | | $132.31 | $192.44 | $260.64 |