- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.44 / $143.44 / $197.18
| Professional | | $143.44 | $143.44 | $197.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.33 / $161.43 / $226.75
| Professional | | $141.33 | $161.43 | $226.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.87 / $185.49 / $251.04
| Professional | | $144.87 | $185.49 | $251.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.12 / $165.01 / $253.14
| Professional | | $128.12 | $165.01 | $253.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.44 / $143.44 / $197.18
| Professional | | $143.44 | $143.44 | $197.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.36 / $170.26 / $229.66
| Professional | | $140.36 | $170.26 | $229.66 |