- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.28 / $156.84 / $269.76
| Professional | | $108.28 | $156.84 | $269.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.69 / $176.13 / $264.89
| Professional | | $125.69 | $176.13 | $264.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.53 / $227.20 / $329.28
| Professional | | $141.53 | $227.20 | $329.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.74 / $203.21 / $316.19
| Professional | | $139.74 | $203.21 | $316.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.28 / $156.84 / $269.76
| Professional | | $108.28 | $156.84 | $269.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.65 / $241.62 / $333.60
| Professional | | $183.65 | $241.62 | $333.60 |