- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.31 / $193.46 / $332.50
| Professional | | $120.31 | $193.46 | $332.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.71 / $225.77 / $326.14
| Professional | | $143.71 | $225.77 | $326.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.62 / $258.61 / $391.28
| Professional | | $163.62 | $258.61 | $391.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.28 / $250.01 / $389.33
| Professional | | $151.28 | $250.01 | $389.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.60 / $198.50 / $332.50
| Professional | | $121.60 | $198.50 | $332.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.48 / $280.48 / $412.57
| Professional | | $199.48 | $280.48 | $412.57 |