- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $263.03
| Professional | | $144.54 | $181.97 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $223.87 / $363.08
| Professional | | $144.54 | $223.87 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $60.26
| Professional | | $32.36 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $239.88 / $302.00
| Professional | | $173.78 | $239.88 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $288.40 / $331.13
| Professional | | $131.83 | $288.40 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $208.93 / $288.40
| Professional | | $162.18 | $208.93 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $288.40
| Professional | | $144.54 | $186.21 | $288.40 |