- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.15 / $135.59 / $172.25
| Professional | | $101.15 | $135.59 | $172.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.55 / $326.47 / $423.30
| Professional | | $178.55 | $326.47 | $423.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.97 / $326.58 / $538.30
| Professional | | $212.97 | $326.58 | $538.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.65 / $299.82 / $488.80
| Professional | | $189.65 | $299.82 | $488.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.34 / $244.40 / $490.27
| Professional | | $141.34 | $244.40 | $490.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.49 / $264.16 / $479.39
| Professional | | $141.49 | $264.16 | $479.39 |