- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.18 / $208.55 / $285.26
| Professional | | $153.18 | $208.55 | $285.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.79 / $169.65 / $236.65
| Professional | | $134.79 | $169.65 | $236.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.63 / $234.45 / $426.18
| Professional | | $155.63 | $234.45 | $426.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.81 / $258.60 / $383.10
| Professional | | $196.81 | $258.60 | $383.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.12 / $238.37 / $425.51
| Professional | | $176.12 | $238.37 | $425.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.61 / $256.38 / $316.50
| Professional | | $168.61 | $256.38 | $316.50 |