- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $389.05
| Professional | | $120.23 | $151.36 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $181.97 / $251.19
| Professional | | $114.82 | $181.97 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $177.83 / $288.40
| Professional | | $154.88 | $177.83 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $173.78 / $257.04
| Professional | | $144.54 | $173.78 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $398.11
| Professional | | $120.23 | $151.36 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $186.21 / $281.84
| Professional | | $138.04 | $186.21 | $281.84 |