- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.81 / $155.01 / $205.34
| Professional | | $122.81 | $155.01 | $205.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.81 / $177.85 / $255.62
| Professional | | $145.81 | $177.85 | $255.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.19 / $234.90 / $370.06
| Professional | | $163.19 | $234.90 | $370.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.47 / $225.89 / $400.93
| Professional | | $164.47 | $225.89 | $400.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.81 / $155.01 / $205.34
| Professional | | $122.81 | $155.01 | $205.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.17 / $235.38 / $351.48
| Professional | | $168.17 | $235.38 | $351.48 |