- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.04 / $144.35 / $154.40
| Professional | | $117.04 | $144.35 | $154.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.32 / $180.56 / $340.58
| Professional | | $150.32 | $180.56 | $340.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.59 / $160.59 / $273.58
| Professional | | $120.59 | $160.59 | $273.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.05 / $162.01 / $299.77
| Professional | | $124.05 | $162.01 | $299.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.04 / $144.35 / $154.40
| Professional | | $117.04 | $144.35 | $154.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.83 / $151.79 / $240.72
| Professional | | $105.83 | $151.79 | $240.72 |