- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.15 / $129.19 / $166.82
| Professional | | $124.15 | $129.19 | $166.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.34 / $184.30 / $514.39
| Professional | | $156.34 | $184.30 | $514.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $193.77 / $316.20
| Professional | | $138.04 | $193.77 | $316.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.19 / $193.77 / $316.20
| Professional | | $145.19 | $193.77 | $316.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.16 / $195.37 / $577.36
| Professional | | $167.16 | $195.37 | $577.36 |