- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.54 / $110.16 / $266.58
| Professional | | $104.54 | $110.16 | $266.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.46 / $191.60 / $251.00
| Professional | | $157.46 | $191.60 | $251.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.56 / $154.29 / $351.46
| Professional | | $97.56 | $154.29 | $351.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.65 / $256.06 / $302.38
| Professional | | $121.65 | $256.06 | $302.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.36 / $123.60 / $357.32
| Professional | | $91.36 | $123.60 | $357.32 |