- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $416.87
| Professional | | $131.83 | $234.42 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $213.80 / $346.74
| Professional | | $138.04 | $213.80 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $302.00 / $524.81
| Professional | | $173.78 | $302.00 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $371.54 / $602.56
| Professional | | $173.78 | $371.54 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $281.84 / $691.83
| Professional | | $144.54 | $281.84 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $537.03
| Professional | | $138.04 | $234.42 | $537.03 |