- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.91 / $155.47 / $250.98
| Professional | | $124.91 | $155.47 | $250.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.39 / $155.24 / $259.14
| Professional | | $121.39 | $155.24 | $259.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.38 / $151.79 / $295.99
| Professional | | $146.38 | $151.79 | $295.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.52 / $191.33 / $331.05
| Professional | | $135.52 | $191.33 | $331.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.29 / $144.11 / $259.41
| Professional | | $115.29 | $144.11 | $259.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.00 / $203.00 / $299.33
| Professional | | $167.00 | $203.00 | $299.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.07 / $220.06 / $331.73
| Professional | | $141.07 | $220.06 | $331.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.04 / $172.94 / $288.81
| Professional | | $114.04 | $172.94 | $288.81 |