- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.98 / $134.55 / $234.36
| Professional | | $82.98 | $134.55 | $234.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.80 / $164.67 / $212.26
| Professional | | $108.80 | $164.67 | $212.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.19 / $177.74 / $259.52
| Professional | | $114.19 | $177.74 | $259.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.65 / $152.56 / $224.18
| Professional | | $96.65 | $152.56 | $224.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.98 / $134.55 / $234.36
| Professional | | $82.98 | $134.55 | $234.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.22 / $197.03 / $270.22
| Professional | | $142.22 | $197.03 | $270.22 |