- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.32 / $134.71 / $164.10
| Professional | | $108.32 | $134.71 | $164.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.15 / $174.95 / $289.07
| Professional | | $148.15 | $174.95 | $289.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.56 / $196.92 / $280.80
| Professional | | $141.56 | $196.92 | $280.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.79 / $218.43 / $335.08
| Professional | | $188.79 | $218.43 | $335.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.32 / $137.13 / $164.10
| Professional | | $108.32 | $137.13 | $164.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.72 / $178.05 / $230.23
| Professional | | $124.72 | $178.05 | $230.23 |