- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.45 / $124.20 / $146.26
| Professional | | $123.45 | $124.20 | $146.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.22 / $166.91 / $248.61
| Professional | | $133.22 | $166.91 | $248.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.12 / $222.44 / $341.51
| Professional | | $157.12 | $222.44 | $341.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.52 / $194.97 / $303.37
| Professional | | $159.52 | $194.97 | $303.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.45 / $124.20 / $146.26
| Professional | | $123.45 | $124.20 | $146.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.12 / $174.17 / $321.44
| Professional | | $139.12 | $174.17 | $321.44 |