- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.01 / $145.34 / $246.38
| Professional | | $108.01 | $145.34 | $246.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.35 / $285.60 / $430.53
| Professional | | $173.35 | $285.60 | $430.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.66 / $335.38 / $522.26
| Professional | | $207.66 | $335.38 | $522.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.44 / $306.33 / $471.90
| Professional | | $184.44 | $306.33 | $471.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.12 / $260.39 / $522.41
| Professional | | $152.12 | $260.39 | $522.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.83 / $289.62 / $517.75
| Professional | | $154.83 | $289.62 | $517.75 |