- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.07 / $127.68 / $143.91
| Professional | | $121.07 | $127.68 | $143.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.54 / $220.73 / $376.77
| Professional | | $63.54 | $220.73 | $376.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.29 / $151.25 / $359.99
| Professional | | $107.29 | $151.25 | $359.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.06 / $201.37 / $356.14
| Professional | | $164.06 | $201.37 | $356.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.07 / $127.68 / $151.25
| Professional | | $121.07 | $127.68 | $151.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.07 / $241.50 / $346.28
| Professional | | $171.07 | $241.50 | $346.28 |