- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $144.19 / $221.26
| Professional | | $102.33 | $144.19 | $221.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.56 / $325.10 / $507.95
| Professional | | $193.56 | $325.10 | $507.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.40 / $361.39 / $610.02
| Professional | | $219.40 | $361.39 | $610.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.86 / $329.74 / $556.25
| Professional | | $208.86 | $329.74 | $556.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.21 / $285.20 / $782.56
| Professional | | $153.21 | $285.20 | $782.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $278.39 / $545.16
| Professional | | $154.88 | $278.39 | $545.16 |