- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.18 / $190.41 / $243.80
| Professional | | $164.18 | $190.41 | $243.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.88 / $176.77 / $332.48
| Professional | | $141.88 | $176.77 | $332.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $207.51 / $333.06
| Professional | | $147.91 | $207.51 | $333.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.66 / $164.85 / $166.45
| Professional | | $161.66 | $164.85 | $166.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.08 / $203.92 / $334.76
| Professional | | $147.08 | $203.92 | $334.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.94 / $152.94 / $152.94
| Professional | | $152.94 | $152.94 | $152.94 |