- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.37 / $146.43 / $609.10
| Professional | | $118.37 | $146.43 | $609.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.22 / $137.38 / $157.65
| Professional | | $118.22 | $137.38 | $157.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.07 / $178.40 / $372.26
| Professional | | $120.07 | $178.40 | $372.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $199.50 / $316.83
| Professional | | $150.00 | $199.50 | $316.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.38 / $171.57 / $340.31
| Professional | | $125.38 | $171.57 | $340.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.55 / $172.50 / $214.04
| Professional | | $111.55 | $172.50 | $214.04 |