- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.92 / $150.75 / $171.74
| Professional | | $120.92 | $150.75 | $171.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.26 / $108.26 / $108.26
| Professional | | $108.26 | $108.26 | $108.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.39 / $143.00 / $168.74
| Professional | | $104.39 | $143.00 | $168.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.98 / $160.47 / $362.71
| Professional | | $114.98 | $160.47 | $362.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.86 / $132.76 / $198.61
| Professional | | $98.86 | $132.76 | $198.61 |