- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.33 / $141.19 / $245.16
| Professional | | $115.33 | $141.19 | $245.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.50 / $168.50 / $234.26
| Professional | | $134.50 | $168.50 | $234.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.87 / $214.90 / $307.88
| Professional | | $155.87 | $214.90 | $307.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.44 / $179.72 / $279.64
| Professional | | $143.44 | $179.72 | $279.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.33 / $141.19 / $245.16
| Professional | | $115.33 | $141.19 | $245.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.96 / $236.58 / $310.00
| Professional | | $171.96 | $236.58 | $310.00 |