- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.34 / $157.66 / $180.63
| Professional | | $134.34 | $157.66 | $180.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.93 / $217.98 / $330.65
| Professional | | $158.93 | $217.98 | $330.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.15 / $154.15 / $154.15
| Professional | | $154.15 | $154.15 | $154.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.13 / $213.52 / $369.37
| Professional | | $159.13 | $213.52 | $369.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.55 / $157.66 / $187.96
| Professional | | $135.55 | $157.66 | $187.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.03 / $251.34 / $348.88
| Professional | | $153.03 | $251.34 | $348.88 |