- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.11 / $106.97 / $206.78
| Professional | | $72.11 | $106.97 | $206.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.62 / $243.47 / $365.20
| Professional | | $169.62 | $243.47 | $365.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.10 / $265.44 / $929.60
| Professional | | $125.10 | $265.44 | $929.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.62 / $215.85 / $295.67
| Professional | | $169.62 | $215.85 | $295.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.77 / $170.78 / $249.70
| Professional | | $126.77 | $170.78 | $249.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.61 / $202.50 / $315.00
| Professional | | $110.61 | $202.50 | $315.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.40 / $207.30 / $303.10
| Professional | | $169.40 | $207.30 | $303.10 |