- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.59 / $142.53 / $340.78
| Professional | | $108.59 | $142.53 | $340.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.95 / $159.22 / $204.01
| Professional | | $108.95 | $159.22 | $204.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.63 / $166.52 / $185.02
| Professional | | $152.63 | $166.52 | $185.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $130.18 / $163.78
| Professional | | $32.34 | $130.18 | $163.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.86 / $149.25 / $170.72
| Professional | | $126.86 | $149.25 | $170.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.90 / $153.22 / $207.39
| Professional | | $115.90 | $153.22 | $207.39 |