- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.02 / $139.94 / $152.90
| Professional | | $110.02 | $139.94 | $152.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.45 / $169.85 / $232.71
| Professional | | $117.45 | $169.85 | $232.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.96 / $203.81 / $310.39
| Professional | | $134.96 | $203.81 | $310.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.87 / $148.38 / $263.38
| Professional | | $65.87 | $148.38 | $263.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.02 / $139.94 / $146.97
| Professional | | $110.02 | $139.94 | $146.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.31 / $177.10 / $249.17
| Professional | | $145.31 | $177.10 | $249.17 |