- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $147.91 / $239.88
| Professional | | $120.23 | $147.91 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $194.98 / $194.98
| Professional | | $123.03 | $194.98 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $165.96 / $204.17
| Professional | | $120.23 | $165.96 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $151.36 / $213.80
| Professional | | $125.89 | $151.36 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $154.88 / $204.17
| Professional | | $144.54 | $154.88 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $162.18 / $223.87
| Professional | | $131.83 | $162.18 | $223.87 |