- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.09 / $240.55 / $337.03
| Professional | | $150.09 | $240.55 | $337.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.81 / $276.01 / $370.33
| Professional | | $174.81 | $276.01 | $370.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.49 / $308.98 / $454.32
| Professional | | $195.49 | $308.98 | $454.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.54 / $286.79 / $453.47
| Professional | | $173.54 | $286.79 | $453.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.46 / $260.18 / $374.35
| Professional | | $186.46 | $260.18 | $374.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.61 / $350.28 / $482.36
| Professional | | $282.61 | $350.28 | $482.36 |