- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.47 / $135.54 / $331.34
| Professional | | $117.47 | $135.54 | $331.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.43 / $176.46 / $339.44
| Professional | | $117.43 | $176.46 | $339.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.69 / $236.05 / $326.24
| Professional | | $132.69 | $236.05 | $326.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.77 / $158.80 / $428.25
| Professional | | $124.77 | $158.80 | $428.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.22 / $164.47 / $223.40
| Professional | | $143.22 | $164.47 | $223.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.36 / $170.68 / $274.24
| Professional | | $119.36 | $170.68 | $274.24 |