- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.17 / $110.47 / $185.15
| Professional | | $106.17 | $110.47 | $185.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.26 / $172.12 / $172.12
| Professional | | $152.26 | $172.12 | $172.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.40 / $153.00 / $234.72
| Professional | | $132.40 | $153.00 | $234.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.57 / $165.34 / $258.77
| Professional | | $120.57 | $165.34 | $258.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.51 / $103.51 / $103.51
| Professional | | $103.51 | $103.51 | $103.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.83 / $140.57 / $215.10
| Professional | | $101.83 | $140.57 | $215.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.10 / $156.91 / $241.16
| Professional | | $110.10 | $156.91 | $241.16 |