- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.68 / $145.06 / $248.56
| Professional | | $138.68 | $145.06 | $248.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.29 / $184.15 / $250.59
| Professional | | $142.29 | $184.15 | $250.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $206.17 / $321.64
| Professional | | $107.15 | $206.17 | $321.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.82 / $195.07 / $288.99
| Professional | | $162.82 | $195.07 | $288.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.68 / $161.37 / $251.92
| Professional | | $138.68 | $161.37 | $251.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.72 / $181.93 / $288.99
| Professional | | $123.72 | $181.93 | $288.99 |