- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $208.93 / $331.13
| Professional | | $147.91 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $363.08 / $363.08
| Professional | | $151.36 | $363.08 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $223.87 / $407.38
| Professional | | $151.36 | $223.87 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $234.42 / $331.13
| Professional | | $158.49 | $234.42 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $208.93 / $380.19
| Professional | | $134.90 | $208.93 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $218.78 / $302.00
| Professional | | $169.82 | $218.78 | $302.00 |