- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.75 / $147.16 / $232.82
| Professional | | $107.75 | $147.16 | $232.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.35 / $165.35 / $230.17
| Professional | | $120.35 | $165.35 | $230.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.52 / $232.35 / $525.33
| Professional | | $149.52 | $232.35 | $525.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.80 / $174.57 / $323.02
| Professional | | $148.80 | $174.57 | $323.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.16 / $200.97 / $232.82
| Professional | | $108.16 | $200.97 | $232.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.33 / $190.10 / $327.19
| Professional | | $123.33 | $190.10 | $327.19 |