- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.11 / $169.56 / $197.20
| Professional | | $132.11 | $169.56 | $197.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.19 / $172.00 / $269.27
| Professional | | $142.19 | $172.00 | $269.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.31 / $127.76 / $166.06
| Professional | | $99.31 | $127.76 | $166.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.87 / $220.19 / $254.40
| Professional | | $164.87 | $220.19 | $254.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.60 / $156.27 / $311.76
| Professional | | $132.60 | $156.27 | $311.76 |