- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.08 / $152.94 / $258.61
| Professional | | $152.08 | $152.94 | $258.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.00 / $125.89 / $220.03
| Professional | | $105.00 | $125.89 | $220.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.00 / $200.73 / $784.59
| Professional | | $145.00 | $200.73 | $784.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.08 / $121.08 / $121.08
| Professional | | $121.08 | $121.08 | $121.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.03 / $148.02 / $230.35
| Professional | | $115.03 | $148.02 | $230.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.78 / $170.27 / $310.14
| Professional | | $129.78 | $170.27 | $310.14 |