- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.67 / $141.33 / $224.22
| Professional | | $119.67 | $141.33 | $224.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.53 / $202.64 / $460.06
| Professional | | $130.53 | $202.64 | $460.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.87 / $210.20 / $242.31
| Professional | | $134.87 | $210.20 | $242.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.84 / $177.26 / $325.02
| Professional | | $121.84 | $177.26 | $325.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.45 / $198.42 / $460.39
| Professional | | $126.45 | $198.42 | $460.39 |