- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.13 / $174.46 / $306.30
| Professional | | $141.13 | $174.46 | $306.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.12 / $205.60 / $290.14
| Professional | | $164.12 | $205.60 | $290.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.32 / $265.04 / $379.72
| Professional | | $189.32 | $265.04 | $379.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.36 / $222.59 / $346.35
| Professional | | $174.36 | $222.59 | $346.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.13 / $174.46 / $306.30
| Professional | | $141.13 | $174.46 | $306.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.70 / $256.32 / $358.51
| Professional | | $190.70 | $256.32 | $358.51 |