- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.15 / $121.85 / $175.79
| Professional | | $101.15 | $121.85 | $175.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.60 / $149.26 / $244.37
| Professional | | $97.60 | $149.26 | $244.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.59 / $108.24 / $144.32
| Professional | | $82.59 | $108.24 | $144.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.67 / $141.97 / $193.03
| Professional | | $106.67 | $141.97 | $193.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.38 / $127.37 / $215.95
| Professional | | $91.38 | $127.37 | $215.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.25 / $103.25 / $103.25
| Professional | | $103.25 | $103.25 | $103.25 |