- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.57 / $230.32 / $368.51
| Professional | | $144.57 | $230.32 | $368.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.00 / $184.31 / $291.37
| Professional | | $126.00 | $184.31 | $291.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.83 / $265.00 / $456.37
| Professional | | $175.83 | $265.00 | $456.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.74 / $141.36 / $172.60
| Professional | | $139.74 | $141.36 | $172.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.39 / $225.28 / $355.73
| Professional | | $155.39 | $225.28 | $355.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.56 / $323.94 / $653.96
| Professional | | $250.56 | $323.94 | $653.96 |