- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.58 / $154.68 / $180.63
| Professional | | $139.58 | $154.68 | $180.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.49 / $161.49 / $220.84
| Professional | | $161.49 | $161.49 | $220.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.15 / $154.15 / $186.82
| Professional | | $154.15 | $154.15 | $186.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.52 / $175.52 / $175.52
| Professional | | $175.52 | $175.52 | $175.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.17 / $175.14 / $215.62
| Professional | | $134.17 | $175.14 | $215.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.09 / $192.45 / $345.15
| Professional | | $155.09 | $192.45 | $345.15 |