- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $269.15
| Professional | | $114.82 | $144.54 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $162.18 / $194.98
| Professional | | $120.23 | $162.18 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $186.21 / $245.47
| Professional | | $134.90 | $186.21 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $173.78 / $1,148.15
| Professional | | $125.89 | $173.78 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $144.54 / $199.53
| Professional | | $112.20 | $144.54 | $199.53 |