- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.21 / $132.25 / $182.04
| Professional | | $119.21 | $132.25 | $182.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.98 / $137.22 / $239.53
| Professional | | $120.98 | $137.22 | $239.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.56 / $165.89 / $291.54
| Professional | | $127.56 | $165.89 | $291.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.49 / $207.74 / $427.45
| Professional | | $138.49 | $207.74 | $427.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.66 / $198.87 / $326.39
| Professional | | $134.66 | $198.87 | $326.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.18 / $111.30 / $141.65
| Professional | | $101.18 | $111.30 | $141.65 |