- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.93 / $105.28 / $156.32
| Professional | | $83.93 | $105.28 | $156.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.54 / $149.34 / $242.13
| Professional | | $102.54 | $149.34 | $242.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.01 / $193.06 / $294.64
| Professional | | $118.01 | $193.06 | $294.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.39 / $193.52 / $362.32
| Professional | | $117.39 | $193.52 | $362.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.19 / $167.13 / $328.73
| Professional | | $121.19 | $167.13 | $328.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.63 / $102.76 / $151.05
| Professional | | $85.63 | $102.76 | $151.05 |