- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.08 / $148.08 / $221.47
| Professional | | $112.08 | $148.08 | $221.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.77 / $160.97 / $268.18
| Professional | | $107.77 | $160.97 | $268.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.87 / $179.59 / $307.00
| Professional | | $133.87 | $179.59 | $307.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.26 / $75.73 / $103.67
| Professional | | $68.26 | $75.73 | $103.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.81 / $150.60 / $237.54
| Professional | | $109.81 | $150.60 | $237.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.60 / $211.73 / $360.79
| Professional | | $136.60 | $211.73 | $360.79 |