- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.18 / $177.58 / $228.66
| Professional | | $176.18 | $177.58 | $228.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.62 / $173.27 / $255.50
| Professional | | $138.62 | $173.27 | $255.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.65 / $193.67 / $284.13
| Professional | | $149.65 | $193.67 | $284.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.53 / $181.40 / $260.56
| Professional | | $161.53 | $181.40 | $260.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.91 / $164.91 / $247.37
| Professional | | $164.91 | $164.91 | $247.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.57 / $179.45 / $306.82
| Professional | | $158.57 | $179.45 | $306.82 |