- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.98 / $128.53 / $162.68
| Professional | | $112.98 | $128.53 | $162.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.56 / $145.29 / $205.18
| Professional | | $129.56 | $145.29 | $205.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.47 / $148.76 / $235.74
| Professional | | $114.47 | $148.76 | $235.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.91 / $138.31 / $255.92
| Professional | | $105.91 | $138.31 | $255.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.98 / $133.34 / $181.25
| Professional | | $112.98 | $133.34 | $181.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.25 / $148.71 / $204.51
| Professional | | $100.25 | $148.71 | $204.51 |