- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.62 / $144.35 / $207.14
| Professional | | $123.62 | $144.35 | $207.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.34 / $158.55 / $268.58
| Professional | | $124.34 | $158.55 | $268.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.80 / $192.99 / $329.98
| Professional | | $147.80 | $192.99 | $329.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.81 / $196.81 / $196.81
| Professional | | $196.81 | $196.81 | $196.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.81 / $150.60 / $235.77
| Professional | | $109.81 | $150.60 | $235.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.48 / $162.43 / $342.29
| Professional | | $123.48 | $162.43 | $342.29 |