- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.40 / $167.56 / $216.89
| Professional | | $128.40 | $167.56 | $216.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.35 / $201.05 / $358.94
| Professional | | $170.35 | $201.05 | $358.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.36 / $190.43 / $306.11
| Professional | | $146.36 | $190.43 | $306.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.72 / $170.71 / $315.87
| Professional | | $130.72 | $170.71 | $315.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.40 / $173.37 / $185.36
| Professional | | $128.40 | $173.37 | $185.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.19 / $185.28 / $253.78
| Professional | | $133.19 | $185.28 | $253.78 |