- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.19 / $195.63 / $290.45
| Professional | | $161.19 | $195.63 | $290.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.22 / $195.28 / $206.77
| Professional | | $156.22 | $195.28 | $206.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.34 / $146.56 / $164.01
| Professional | | $134.34 | $146.56 | $164.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.65 / $139.65 / $146.00
| Professional | | $139.65 | $139.65 | $146.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.19 / $202.25 / $326.80
| Professional | | $138.19 | $202.25 | $326.80 |