- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.81 / $114.23 / $159.27
| Professional | | $98.81 | $114.23 | $159.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.06 / $232.18 / $272.24
| Professional | | $211.06 | $232.18 | $272.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.66 / $215.26 / $342.98
| Professional | | $115.66 | $215.26 | $342.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.54 / $173.56 / $888.45
| Professional | | $104.54 | $173.56 | $888.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.06 / $173.56 / $282.85
| Professional | | $106.06 | $173.56 | $282.85 |