- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $131.83 / $186.21
| Professional | | $107.15 | $131.83 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $128.82 / $234.42
| Professional | | $89.13 | $128.82 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $158.49 / $295.12
| Professional | | $107.15 | $158.49 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $169.82 / $426.58
| Professional | | $138.04 | $169.82 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $123.03 / $239.88
| Professional | | $63.10 | $123.03 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $144.54 / $288.40
| Professional | | $109.65 | $144.54 | $288.40 |