- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.08 / $93.06 / $138.30
| Professional | | $92.08 | $93.06 | $138.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.27 / $427.27 / $427.27
| Professional | | $427.27 | $427.27 | $427.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.85 / $145.76 / $261.14
| Professional | | $97.85 | $145.76 | $261.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.70 / $154.88 / $226.30
| Professional | | $102.70 | $154.88 | $226.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.35 / $164.02 / $476.83
| Professional | | $155.35 | $164.02 | $476.83 |