- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.14 / $140.26 / $152.75
| Professional | | $115.14 | $140.26 | $152.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.72 / $175.45 / $251.97
| Professional | | $127.72 | $175.45 | $251.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.25 / $214.32 / $349.99
| Professional | | $143.25 | $214.32 | $349.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.15 / $204.45 / $318.12
| Professional | | $140.15 | $204.45 | $318.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.14 / $136.36 / $173.73
| Professional | | $115.14 | $136.36 | $173.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.62 / $219.19 / $338.44
| Professional | | $156.62 | $219.19 | $338.44 |