- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.80 / $154.75 / $184.94
| Professional | | $130.80 | $154.75 | $184.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.68 / $191.76 / $238.14
| Professional | | $142.68 | $191.76 | $238.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.04 / $198.74 / $282.08
| Professional | | $147.04 | $198.74 | $282.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.10 / $193.55 / $1,377.92
| Professional | | $150.10 | $193.55 | $1,377.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.25 / $181.70 / $259.52
| Professional | | $147.25 | $181.70 | $259.52 |