- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.48 / $148.75 / $213.05
| Professional | | $107.48 | $148.75 | $213.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.56 / $153.60 / $223.57
| Professional | | $130.56 | $153.60 | $223.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.06 / $218.63 / $353.41
| Professional | | $144.06 | $218.63 | $353.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.27 / $221.35 / $392.87
| Professional | | $144.27 | $221.35 | $392.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.23 / $167.10 / $280.54
| Professional | | $118.23 | $167.10 | $280.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.84 / $221.92 / $357.18
| Professional | | $161.84 | $221.92 | $357.18 |