- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.28 / $133.36 / $182.63
| Professional | | $110.28 | $133.36 | $182.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.12 / $146.00 / $238.41
| Professional | | $92.12 | $146.00 | $238.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.47 / $170.75 / $222.72
| Professional | | $148.47 | $170.75 | $222.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $172.38 / $289.52
| Professional | | $131.16 | $172.38 | $289.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.86 / $164.55 / $264.72
| Professional | | $126.86 | $164.55 | $264.72 |