- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.74 / $140.34 / $198.65
| Professional | | $100.74 | $140.34 | $198.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.58 / $148.91 / $214.15
| Professional | | $126.58 | $148.91 | $214.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.97 / $215.13 / $307.32
| Professional | | $136.97 | $215.13 | $307.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.15 / $195.38 / $346.78
| Professional | | $140.15 | $195.38 | $346.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.59 / $140.34 / $198.65
| Professional | | $99.59 | $140.34 | $198.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.08 / $211.22 / $317.10
| Professional | | $135.08 | $211.22 | $317.10 |