- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $147.91 / $223.87
| Professional | | $114.82 | $147.91 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $186.21 / $281.84
| Professional | | $144.54 | $186.21 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $181.97 / $281.84
| Professional | | $141.25 | $181.97 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $229.09 / $691.83
| Professional | | $151.36 | $229.09 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $151.36
| Professional | | $120.23 | $151.36 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $190.55 / $281.84
| Professional | | $138.04 | $190.55 | $281.84 |