- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.81 / $186.71 / $337.13
| Professional | | $115.81 | $186.71 | $337.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.91 / $230.88 / $327.14
| Professional | | $149.91 | $230.88 | $327.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.33 / $266.77 / $483.63
| Professional | | $153.33 | $266.77 | $483.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.93 / $252.73 / $413.06
| Professional | | $152.93 | $252.73 | $413.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.59 / $214.71 / $337.13
| Professional | | $135.59 | $214.71 | $337.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.33 / $290.16 / $443.54
| Professional | | $214.33 | $290.16 | $443.54 |