- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.15 / $115.95 / $125.22
| Professional | | $101.15 | $115.95 | $125.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.39 / $173.67 / $246.09
| Professional | | $125.39 | $173.67 | $246.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.44 / $93.51 / $114.31
| Professional | | $71.44 | $93.51 | $114.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.70 / $161.74 / $205.78
| Professional | | $124.70 | $161.74 | $205.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.64 / $119.74 / $178.29
| Professional | | $91.64 | $119.74 | $178.29 |