- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.30 / $146.27 / $180.78
| Professional | | $114.30 | $146.27 | $180.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.46 / $113.73 / $192.75
| Professional | | $29.46 | $113.73 | $192.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.81 / $157.50 / $234.85
| Professional | | $107.81 | $157.50 | $234.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.16 / $146.27 / $225.02
| Professional | | $141.16 | $146.27 | $225.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.81 / $136.69 / $195.77
| Professional | | $109.81 | $136.69 | $195.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.30 / $190.94 / $238.77
| Professional | | $155.30 | $190.94 | $238.77 |