- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.57 / $126.10 / $158.84
| Professional | | $108.57 | $126.10 | $158.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.51 / $162.10 / $223.71
| Professional | | $152.51 | $162.10 | $223.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.28 / $189.56 / $267.66
| Professional | | $123.28 | $189.56 | $267.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.40 / $179.80 / $275.82
| Professional | | $155.40 | $179.80 | $275.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.57 / $126.10 / $158.84
| Professional | | $108.57 | $126.10 | $158.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.01 / $170.74 / $246.43
| Professional | | $108.01 | $170.74 | $246.43 |