- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.41 / $153.62 / $216.24
| Professional | | $107.41 | $153.62 | $216.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.74 / $182.27 / $254.34
| Professional | | $128.74 | $182.27 | $254.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $191.14 / $301.27
| Professional | | $129.63 | $191.14 | $301.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.06 / $193.95 / $356.14
| Professional | | $164.06 | $193.95 | $356.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.53 / $153.62 / $285.11
| Professional | | $138.53 | $153.62 | $285.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.10 / $188.47 / $297.11
| Professional | | $121.10 | $188.47 | $297.11 |