- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.49 / $138.46 / $167.90
| Professional | | $101.49 | $138.46 | $167.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.46 / $122.02 / $179.03
| Professional | | $95.46 | $122.02 | $179.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.96 / $188.12 / $321.12
| Professional | | $101.96 | $188.12 | $321.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.02 / $283.82 / $1,128.08
| Professional | | $153.02 | $283.82 | $1,128.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.38 / $205.84 / $317.01
| Professional | | $148.38 | $205.84 | $317.01 |