- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $151.36 / $281.84
| Professional | | $125.89 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $190.55 / $263.03
| Professional | | $112.20 | $190.55 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $169.82 / $275.42
| Professional | | $154.88 | $169.82 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $169.82 / $251.19
| Professional | | $138.04 | $169.82 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $173.78 / $416.87
| Professional | | $125.89 | $173.78 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $181.97 / $275.42
| Professional | | $134.90 | $181.97 | $275.42 |