- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.56 / $148.44 / $218.91
| Professional | | $136.56 | $148.44 | $218.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.15 / $169.38 / $196.04
| Professional | | $141.15 | $169.38 | $196.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.66 / $217.59 / $256.76
| Professional | | $193.66 | $217.59 | $256.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.38 / $172.51 / $196.04
| Professional | | $129.38 | $172.51 | $196.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.97 / $253.25 / $287.73
| Professional | | $159.97 | $253.25 | $287.73 |