- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.42 / $162.69 / $237.48
| Professional | | $100.42 | $162.69 | $237.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.18 / $213.36 / $309.37
| Professional | | $134.18 | $213.36 | $309.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.87 / $244.74 / $403.66
| Professional | | $140.87 | $244.74 | $403.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.87 / $251.03 / $422.63
| Professional | | $157.87 | $251.03 | $422.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.42 / $162.69 / $350.46
| Professional | | $100.42 | $162.69 | $350.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.03 / $273.76 / $414.83
| Professional | | $193.03 | $273.76 | $414.83 |