- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.58 / $141.57 / $282.13
| Professional | | $89.58 | $141.57 | $282.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.66 / $186.22 / $271.77
| Professional | | $122.66 | $186.22 | $271.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.01 / $213.82 / $351.25
| Professional | | $122.01 | $213.82 | $351.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.66 / $220.53 / $371.28
| Professional | | $137.66 | $220.53 | $371.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.57 / $141.57 / $282.13
| Professional | | $89.57 | $141.57 | $282.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.49 / $239.41 / $364.28
| Professional | | $159.49 | $239.41 | $364.28 |