- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $237.48 / $283.74
| Professional | | $136.32 | $237.48 | $283.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.88 / $227.67 / $351.55
| Professional | | $132.88 | $227.67 | $351.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.54 / $244.80 / $481.42
| Professional | | $136.54 | $244.80 | $481.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.57 / $261.92 / $486.03
| Professional | | $147.57 | $261.92 | $486.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.32 / $238.56 / $326.47
| Professional | | $136.32 | $238.56 | $326.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.37 / $318.83 / $466.28
| Professional | | $201.37 | $318.83 | $466.28 |