- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.29 / $191.76 / $223.37
| Professional | | $158.29 | $191.76 | $223.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.88 / $308.75 / $385.94
| Professional | | $277.88 | $308.75 | $385.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.50 / $184.50 / $345.65
| Professional | | $184.50 | $184.50 | $345.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.19 / $222.21 / $254.24
| Professional | | $172.19 | $222.21 | $254.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.30 / $202.42 / $288.32
| Professional | | $164.30 | $202.42 | $288.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.89 / $248.91 / $307.93
| Professional | | $203.89 | $248.91 | $307.93 |