- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.37 / $155.11 / $176.41
| Professional | | $115.37 | $155.11 | $176.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.62 / $209.37 / $290.85
| Professional | | $125.62 | $209.37 | $290.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.53 / $249.35 / $377.43
| Professional | | $150.53 | $249.35 | $377.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.44 / $242.37 / $377.13
| Professional | | $150.44 | $242.37 | $377.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.37 / $148.18 / $194.30
| Professional | | $115.37 | $148.18 | $194.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.33 / $233.28 / $379.56
| Professional | | $159.33 | $233.28 | $379.56 |