- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.71 / $111.42 / $345.57
| Professional | | $102.71 | $111.42 | $345.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.92 / $275.02 / $343.78
| Professional | | $264.92 | $275.02 | $343.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.91 / $241.54 / $1,156.83
| Professional | | $144.91 | $241.54 | $1,156.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.68 / $264.92 / $324.27
| Professional | | $228.68 | $264.92 | $324.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.37 / $200.75 / $235.47
| Professional | | $151.37 | $200.75 | $235.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.91 / $241.54 / $342.55
| Professional | | $144.91 | $241.54 | $342.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.50 / $270.00 / $280.80
| Professional | | $229.50 | $270.00 | $280.80 |