- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.87 / $115.32 / $163.69
| Professional | | $107.87 | $115.32 | $163.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.50 / $212.52 / $350.47
| Professional | | $146.50 | $212.52 | $350.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.14 / $137.72 / $144.78
| Professional | | $115.14 | $137.72 | $144.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.00 / $114.00 / $136.80
| Professional | | $114.00 | $114.00 | $136.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.66 / $254.81 / $440.00
| Professional | | $161.66 | $254.81 | $440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.36 / $254.81 / $441.30
| Professional | | $136.36 | $254.81 | $441.30 |