- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.94 / $159.15 / $168.30
| Professional | | $135.94 | $159.15 | $168.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.27 / $177.58 / $330.51
| Professional | | $131.27 | $177.58 | $330.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.63 / $214.34 / $336.33
| Professional | | $163.63 | $214.34 | $336.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.87 / $182.66 / $430.20
| Professional | | $157.87 | $182.66 | $430.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.94 / $159.15 / $202.17
| Professional | | $135.94 | $159.15 | $202.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.79 / $217.08 / $338.92
| Professional | | $132.79 | $217.08 | $338.92 |