- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.09 / $170.63 / $202.21
| Professional | | $138.09 | $170.63 | $202.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.98 / $178.46 / $230.27
| Professional | | $118.98 | $178.46 | $230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.50 / $199.62 / $241.96
| Professional | | $135.50 | $199.62 | $241.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $200.85
| Professional | | $32.34 | $32.34 | $200.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.07 / $185.07 / $206.59
| Professional | | $150.07 | $185.07 | $206.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.69 / $184.36 / $248.88
| Professional | | $138.69 | $184.36 | $248.88 |