- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.41 / $227.05 / $449.17
| Professional | | $141.41 | $227.05 | $449.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $201.64 / $403.20
| Professional | | $129.63 | $201.64 | $403.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.26 / $227.96 / $421.90
| Professional | | $138.26 | $227.96 | $421.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.42 / $215.54 / $404.38
| Professional | | $116.42 | $215.54 | $404.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.71 / $202.07 / $318.62
| Professional | | $134.71 | $202.07 | $318.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.82 / $267.73 / $437.96
| Professional | | $190.82 | $267.73 | $437.96 |