- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.86 / $204.78 / $282.93
| Professional | | $141.86 | $204.78 | $282.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.17 / $155.30 / $214.20
| Professional | | $118.17 | $155.30 | $214.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.77 / $206.28 / $328.01
| Professional | | $158.77 | $206.28 | $328.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.83 / $260.27 / $462.84
| Professional | | $162.83 | $260.27 | $462.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $64.25 / $247.70
| Professional | | $32.34 | $64.25 | $247.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.86 / $298.75 / $467.10
| Professional | | $204.86 | $298.75 | $467.10 |