- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.21 / $139.50 / $204.07
| Professional | | $117.21 | $139.50 | $204.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.00 / $143.37 / $151.97
| Professional | | $143.00 | $143.37 | $151.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.61 / $191.76 / $344.42
| Professional | | $128.61 | $191.76 | $344.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.32 / $204.23 / $270.42
| Professional | | $158.32 | $204.23 | $270.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.54 / $166.08 / $316.39
| Professional | | $118.54 | $166.08 | $316.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.28 / $182.07 / $226.52
| Professional | | $142.28 | $182.07 | $226.52 |