- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.77 / $128.24 / $158.78
| Professional | | $119.77 | $128.24 | $158.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.32 / $193.70 / $267.30
| Professional | | $134.32 | $193.70 | $267.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.70 / $142.44 / $178.05
| Professional | | $118.70 | $142.44 | $178.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.97 / $169.11 / $360.37
| Professional | | $133.97 | $169.11 | $360.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.06 / $159.19 / $351.09
| Professional | | $124.06 | $159.19 | $351.09 |