- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.10 / $120.94 / $161.26
| Professional | | $118.10 | $120.94 | $161.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.72 / $162.02 / $230.06
| Professional | | $128.72 | $162.02 | $230.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.79 / $111.47 / $147.74
| Professional | | $13.79 | $111.47 | $147.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.70 / $172.32 / $270.06
| Professional | | $126.70 | $172.32 | $270.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.96 / $143.26 / $250.81
| Professional | | $116.96 | $143.26 | $250.81 |