- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.71 / $106.26 / $145.16
| Professional | | $101.71 | $106.26 | $145.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.62 / $161.04 / $449.49
| Professional | | $136.62 | $161.04 | $449.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.16 / $167.91 / $272.73
| Professional | | $115.16 | $167.91 | $272.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.40 / $169.15 / $272.73
| Professional | | $120.40 | $169.15 | $272.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.01 / $171.30 / $497.99
| Professional | | $146.01 | $171.30 | $497.99 |