- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.50 / $112.29 / $136.58
| Professional | | $103.50 | $112.29 | $136.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.78 / $144.85 / $144.85
| Professional | | $123.78 | $144.85 | $144.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.03 / $158.94 / $187.55
| Professional | | $116.03 | $158.94 | $187.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.74 / $154.27 / $293.18
| Professional | | $116.74 | $154.27 | $293.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.02 / $133.03 / $182.04
| Professional | | $98.02 | $133.03 | $182.04 |