- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.56 / $159.72 / $183.71
| Professional | | $136.56 | $159.72 | $183.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.32 / $197.36 / $301.39
| Professional | | $153.32 | $197.36 | $301.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.06 / $141.06 / $141.06
| Professional | | $141.06 | $141.06 | $141.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.61 / $195.38 / $337.99
| Professional | | $145.61 | $195.38 | $337.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.56 / $160.49 / $191.28
| Professional | | $136.56 | $160.49 | $191.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.41 / $256.06 / $319.12
| Professional | | $151.41 | $256.06 | $319.12 |