- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.94 / $104.77 / $145.62
| Professional | | $95.94 | $104.77 | $145.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.50 / $284.52 / $372.33
| Professional | | $151.50 | $284.52 | $372.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.16 / $245.66 / $300.74
| Professional | | $168.16 | $245.66 | $300.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.72 / $236.80 / $247.20
| Professional | | $168.72 | $236.80 | $247.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.38 / $215.20 / $3,176.85
| Professional | | $109.38 | $215.20 | $3,176.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.14 / $214.74 / $343.78
| Professional | | $110.14 | $214.74 | $343.78 |