- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.66 / $118.86 / $172.25
| Professional | | $111.66 | $118.86 | $172.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.94 / $101.42 / $183.14
| Professional | | $62.94 | $101.42 | $183.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.86 / $127.26 / $161.97
| Professional | | $114.86 | $127.26 | $161.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.17 / $148.06 / $234.51
| Professional | | $108.17 | $148.06 | $234.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.69 / $158.35 / $234.51
| Professional | | $115.69 | $158.35 | $234.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.08 / $136.77 / $194.71
| Professional | | $105.08 | $136.77 | $194.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.18 / $140.63 / $261.33
| Professional | | $103.18 | $140.63 | $261.33 |