- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.23 / $156.08 / $216.16
| Professional | | $111.23 | $156.08 | $216.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.91 / $171.75 / $239.08
| Professional | | $125.91 | $171.75 | $239.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.80 / $244.60 / $540.96
| Professional | | $155.80 | $244.60 | $540.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.22 / $187.17 / $339.12
| Professional | | $156.22 | $187.17 | $339.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.23 / $156.08 / $216.16
| Professional | | $111.23 | $156.08 | $216.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.38 / $203.08 / $360.32
| Professional | | $140.38 | $203.08 | $360.32 |