- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $133.13 / $169.52
| Professional | | $106.17 | $133.13 | $169.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.02 / $149.10 / $224.15
| Professional | | $110.02 | $149.10 | $224.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.94 / $158.33 / $186.04
| Professional | | $131.94 | $158.33 | $186.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.00 / $188.74 / $307.02
| Professional | | $132.00 | $188.74 | $307.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.20 / $136.01 / $245.86
| Professional | | $106.20 | $136.01 | $245.86 |