- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.47 / $177.46 / $314.24
| Professional | | $110.47 | $177.46 | $314.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.46 / $188.20 / $267.85
| Professional | | $134.46 | $188.20 | $267.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.47 / $252.98 / $306.64
| Professional | | $181.47 | $252.98 | $306.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $217.81 / $274.01
| Professional | | $32.34 | $217.81 | $274.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.92 / $261.22 / $320.62
| Professional | | $190.92 | $261.22 | $320.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.36 / $233.48 / $332.26
| Professional | | $162.36 | $233.48 | $332.26 |