- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.38 / $110.16 / $132.74
| Professional | | $106.38 | $110.16 | $132.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.07 / $116.07 / $152.05
| Professional | | $116.07 | $116.07 | $152.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.56 / $154.81 / $279.36
| Professional | | $97.56 | $154.81 | $279.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.65 / $256.06 / $256.06
| Professional | | $121.65 | $256.06 | $256.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.42 / $123.60 / $268.70
| Professional | | $91.42 | $123.60 | $268.70 |