- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $138.04 / $218.78
| Professional | | $107.15 | $138.04 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $117.49 / $117.49
| Professional | | $117.49 | $117.49 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $147.91 / $269.15
| Professional | | $109.65 | $147.91 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $151.36 / $181.97
| Professional | | $128.82 | $151.36 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $186.21 / $309.03
| Professional | | $123.03 | $186.21 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $131.83 / $213.80
| Professional | | $107.15 | $131.83 | $213.80 |