- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.86 / $150.94 / $334.86
| Professional | | $107.86 | $150.94 | $334.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.62 / $145.62 / $232.60
| Professional | | $145.62 | $145.62 | $232.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.32 / $199.13 / $282.49
| Professional | | $126.32 | $199.13 | $282.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $104.88 / $293.30
| Professional | | $32.34 | $104.88 | $293.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.91 / $207.62 / $336.68
| Professional | | $144.91 | $207.62 | $336.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.19 / $240.60 / $352.88
| Professional | | $159.19 | $240.60 | $352.88 |