- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.83 / $173.80 / $226.06
| Professional | | $144.83 | $173.80 | $226.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.54 / $251.00 / $344.86
| Professional | | $154.54 | $251.00 | $344.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.96 / $317.80 / $507.45
| Professional | | $210.96 | $317.80 | $507.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.96 / $309.30 / $586.26
| Professional | | $185.96 | $309.30 | $586.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.81 / $272.87 / $537.49
| Professional | | $200.81 | $272.87 | $537.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.20 / $157.26 / $204.96
| Professional | | $118.20 | $157.26 | $204.96 |