- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $157.16 / $273.45
| Professional | | $137.84 | $157.16 | $273.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.26 / $230.63 / $391.78
| Professional | | $166.26 | $230.63 | $391.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.62 / $240.19 / $352.03
| Professional | | $152.62 | $240.19 | $352.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.14 / $224.21 / $332.15
| Professional | | $187.14 | $224.21 | $332.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $180.68 / $288.32
| Professional | | $137.84 | $180.68 | $288.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.96 / $212.32 / $318.42
| Professional | | $154.96 | $212.32 | $318.42 |