- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.78 / $147.63 / $191.28
| Professional | | $135.78 | $147.63 | $191.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.06 / $141.06 / $141.06
| Professional | | $141.06 | $141.06 | $141.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.12 / $160.13 / $240.21
| Professional | | $109.12 | $160.13 | $240.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.22 / $169.21 / $332.92
| Professional | | $132.22 | $169.21 | $332.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.85 / $184.16 / $232.68
| Professional | | $130.85 | $184.16 | $232.68 |