- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.09 / $163.87 / $173.73
| Professional | | $161.09 | $163.87 | $173.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.03 / $181.15 / $257.23
| Professional | | $163.03 | $181.15 | $257.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $39.92 / $160.71 / $212.25
| Professional | | $39.92 | $160.71 | $212.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.68 / $249.50 / $466.57
| Professional | | $200.68 | $249.50 | $466.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.23 / $203.00 / $346.09
| Professional | | $169.23 | $203.00 | $346.09 |