- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.48 / $129.09 / $293.76
| Professional | | $84.48 | $129.09 | $293.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.31 / $199.38 / $280.13
| Professional | | $122.31 | $199.38 | $280.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.24 / $256.86 / $319.20
| Professional | | $167.24 | $256.86 | $319.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.77 / $223.39 / $335.37
| Professional | | $174.77 | $223.39 | $335.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.24 / $233.53 / $319.20
| Professional | | $167.24 | $233.53 | $319.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.09 / $254.71 / $289.33
| Professional | | $146.09 | $254.71 | $289.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.77 / $239.44 / $320.80
| Professional | | $174.77 | $239.44 | $320.80 |