- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $122.76 / $174.01
| Professional | | $106.17 | $122.76 | $174.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.32 / $122.82 / $193.60
| Professional | | $96.32 | $122.82 | $193.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.84 / $171.52 / $210.94
| Professional | | $127.84 | $171.52 | $210.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.67 / $180.19 / $352.84
| Professional | | $122.67 | $180.19 | $352.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $140.62
| Professional | | $32.34 | $32.34 | $140.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.59 / $126.38 / $177.53
| Professional | | $107.59 | $126.38 | $177.53 |