- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.04 / $170.81 / $334.86
| Professional | | $112.04 | $170.81 | $334.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.91 / $192.09 / $304.92
| Professional | | $118.91 | $192.09 | $304.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.92 / $158.65 / $277.26
| Professional | | $94.92 | $158.65 | $277.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.88 / $158.94 / $296.52
| Professional | | $94.88 | $158.94 | $296.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.42 / $116.65 / $188.78
| Professional | | $105.42 | $116.65 | $188.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.81 / $193.41 / $323.93
| Professional | | $136.81 | $193.41 | $323.93 |