- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.04 / $146.82 / $166.22
| Professional | | $104.04 | $146.82 | $166.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.16 / $154.91 / $232.48
| Professional | | $129.16 | $154.91 | $232.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.46 / $158.10 / $236.84
| Professional | | $110.46 | $158.10 | $236.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.87 / $153.09 / $287.24
| Professional | | $118.87 | $153.09 | $287.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.04 / $146.82 / $166.22
| Professional | | $104.04 | $146.82 | $166.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.25 / $140.13 / $231.47
| Professional | | $97.25 | $140.13 | $231.47 |