- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.11 / $143.28 / $181.59
| Professional | | $126.11 | $143.28 | $181.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.36 / $147.32 / $195.90
| Professional | | $118.36 | $147.32 | $195.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.81 / $183.13 / $271.35
| Professional | | $131.81 | $183.13 | $271.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.54 / $154.16 / $239.87
| Professional | | $119.54 | $154.16 | $239.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.11 / $143.28 / $181.59
| Professional | | $126.11 | $143.28 | $181.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.72 / $171.33 / $250.31
| Professional | | $146.72 | $171.33 | $250.31 |