- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.15 / $206.43 / $352.92
| Professional | | $113.15 | $206.43 | $352.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.66 / $231.56 / $443.31
| Professional | | $135.66 | $231.56 | $443.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.24 / $213.25 / $434.45
| Professional | | $120.24 | $213.25 | $434.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.94 / $243.50 / $297.87
| Professional | | $145.94 | $243.50 | $297.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.68 / $196.35 / $328.35
| Professional | | $167.68 | $196.35 | $328.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.75 / $292.58 / $525.20
| Professional | | $210.75 | $292.58 | $525.20 |