- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.88 / $172.87 / $227.98
| Professional | | $156.88 | $172.87 | $227.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.71 / $71.16 / $170.77
| Professional | | $36.71 | $71.16 | $170.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.78 / $164.78 / $192.27
| Professional | | $164.78 | $164.78 | $192.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.94 / $179.76 / $320.57
| Professional | | $138.94 | $179.76 | $320.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.94 / $187.25 / $323.82
| Professional | | $138.94 | $187.25 | $323.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.44 / $182.25 / $261.52
| Professional | | $129.44 | $182.25 | $261.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.30 / $175.76 / $305.02
| Professional | | $128.30 | $175.76 | $305.02 |