- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.78 / $171.02 / $172.63
| Professional | | $114.78 | $171.02 | $172.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.20 / $152.01 / $211.94
| Professional | | $109.20 | $152.01 | $211.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.56 / $172.72 / $204.51
| Professional | | $120.56 | $172.72 | $204.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.50 / $215.65 / $1,244.64
| Professional | | $132.50 | $215.65 | $1,244.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.02 / $163.16 / $250.03
| Professional | | $125.02 | $163.16 | $250.03 |