- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.36 / $157.88 / $610.90
| Professional | | $121.36 | $157.88 | $610.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.19 / $248.79 / $344.18
| Professional | | $151.19 | $248.79 | $344.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.85 / $267.77 / $305.18
| Professional | | $187.85 | $267.77 | $305.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.27 / $237.36 / $370.28
| Professional | | $186.27 | $237.36 | $370.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.90 / $269.72 / $347.30
| Professional | | $197.90 | $269.72 | $347.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.57 / $278.33 / $367.15
| Professional | | $211.57 | $278.33 | $367.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.13 / $247.68 / $365.98
| Professional | | $172.13 | $247.68 | $365.98 |