- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.62 / $143.22 / $183.47
| Professional | | $130.62 | $143.22 | $183.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.00 / $139.72 / $222.17
| Professional | | $46.00 | $139.72 | $222.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.38 / $197.83 / $368.36
| Professional | | $128.38 | $197.83 | $368.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.38 / $135.13 / $298.01
| Professional | | $128.38 | $135.13 | $298.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.34 / $166.40 / $343.74
| Professional | | $122.34 | $166.40 | $343.74 |