- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.66 / $167.56 / $216.89
| Professional | | $137.66 | $167.56 | $216.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.10 / $213.58 / $273.64
| Professional | | $140.10 | $213.58 | $273.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.40 / $205.52 / $228.36
| Professional | | $188.40 | $205.52 | $228.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $160.33 / $201.71
| Professional | | $32.34 | $160.33 | $201.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.31 / $185.07 / $225.18
| Professional | | $157.31 | $185.07 | $225.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.72 / $194.77 / $263.82
| Professional | | $144.72 | $194.77 | $263.82 |