- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.81 / $142.86 / $235.35
| Professional | | $118.81 | $142.86 | $235.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.27 / $209.71 / $301.75
| Professional | | $152.27 | $209.71 | $301.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.68 / $282.37 / $397.28
| Professional | | $183.68 | $282.37 | $397.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.43 / $244.85 / $380.99
| Professional | | $183.43 | $244.85 | $380.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.81 / $143.79 / $227.60
| Professional | | $118.81 | $143.79 | $227.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.55 / $202.94 / $405.51
| Professional | | $162.55 | $202.94 | $405.51 |