- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.34 / $210.17 / $324.74
| Professional | | $143.34 | $210.17 | $324.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.18 / $241.71 / $384.39
| Professional | | $142.18 | $241.71 | $384.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.09 / $156.76 / $315.08
| Professional | | $141.09 | $156.76 | $315.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.88 / $249.72 / $452.62
| Professional | | $152.88 | $249.72 | $452.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.60 / $314.86 / $525.00
| Professional | | $251.60 | $314.86 | $525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.00 / $312.00 / $471.75
| Professional | | $256.00 | $312.00 | $471.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.49 / $299.02 / $585.27
| Professional | | $213.49 | $299.02 | $585.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.29 / $258.14 / $454.66
| Professional | | $171.29 | $258.14 | $454.66 |