- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.31 / $206.60 / $296.52
| Professional | | $130.31 | $206.60 | $296.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.88 / $228.46 / $403.87
| Professional | | $132.88 | $228.46 | $403.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.81 / $306.08 / $635.00
| Professional | | $158.81 | $306.08 | $635.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.04 / $304.89 / $708.90
| Professional | | $144.04 | $304.89 | $708.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.94 / $346.41 / $698.33
| Professional | | $230.94 | $346.41 | $698.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.93 / $128.69 / $211.19
| Professional | | $91.93 | $128.69 | $211.19 |