- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.58 / $145.34 / $156.27
| Professional | | $119.58 | $145.34 | $156.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.04 / $171.32 / $306.35
| Professional | | $140.04 | $171.32 | $306.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.93 / $211.18 / $312.38
| Professional | | $144.93 | $211.18 | $312.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.33 / $169.30 / $398.75
| Professional | | $146.33 | $169.30 | $398.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.19 / $154.31 / $222.92
| Professional | | $122.19 | $154.31 | $222.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.70 / $154.44 / $251.72
| Professional | | $126.70 | $154.44 | $251.72 |