- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $208.93 / $295.12
| Professional | | $109.65 | $208.93 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $177.83 / $338.84
| Professional | | $75.86 | $177.83 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $199.53 / $269.15
| Professional | | $109.65 | $199.53 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $288.40
| Professional | | $288.40 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $181.97 / $295.12
| Professional | | $104.71 | $181.97 | $295.12 |