- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.76 / $184.70 / $612.00
| Professional | | $124.76 | $184.70 | $612.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.51 / $196.38 / $289.67
| Professional | | $144.51 | $196.38 | $289.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.77 / $86.94 / $115.57
| Professional | | $68.77 | $86.94 | $115.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.12 / $205.12 / $249.52
| Professional | | $146.12 | $205.12 | $249.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.50 / $165.06 / $236.99
| Professional | | $118.50 | $165.06 | $236.99 |