- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.63 / $148.24 / $244.66
| Professional | | $130.63 | $148.24 | $244.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.22 / $229.28 / $466.79
| Professional | | $141.22 | $229.28 | $466.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.64 / $300.89 / $368.31
| Professional | | $229.64 | $300.89 | $368.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.65 / $185.29 / $295.72
| Professional | | $116.65 | $185.29 | $295.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.02 / $225.77 / $383.28
| Professional | | $163.02 | $225.77 | $383.28 |