- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.38 / $101.17 / $122.13
| Professional | | $75.38 | $101.17 | $122.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.31 / $149.22 / $215.64
| Professional | | $115.31 | $149.22 | $215.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.30 / $169.22 / $292.31
| Professional | | $104.30 | $169.22 | $292.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.60 / $166.53 / $275.20
| Professional | | $149.60 | $166.53 | $275.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.14 / $101.17 / $154.53
| Professional | | $81.14 | $101.17 | $154.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $154.55 / $190.65
| Professional | | $97.72 | $154.55 | $190.65 |