- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.84 / $153.43 / $198.16
| Professional | | $137.84 | $153.43 | $198.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.36 / $178.69 / $281.06
| Professional | | $140.36 | $178.69 | $281.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.43 / $177.18 / $254.58
| Professional | | $124.43 | $177.18 | $254.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.43 / $204.05 / $316.55
| Professional | | $137.43 | $204.05 | $316.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $165.48
| Professional | | $32.34 | $32.34 | $165.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.06 / $173.59 / $232.17
| Professional | | $137.06 | $173.59 | $232.17 |