- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.06 / $142.32 / $182.24
| Professional | | $127.06 | $142.32 | $182.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.80 / $274.51 / $426.20
| Professional | | $183.80 | $274.51 | $426.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.81 / $377.27 / $547.14
| Professional | | $231.81 | $377.27 | $547.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.72 / $310.92 / $462.84
| Professional | | $193.72 | $310.92 | $462.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.29 / $251.81 / $503.95
| Professional | | $150.29 | $251.81 | $503.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.53 / $251.81 / $467.96
| Professional | | $143.53 | $251.81 | $467.96 |