- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.36 / $115.27 / $151.36
| Professional | | $102.36 | $115.27 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.05 / $118.89 / $163.34
| Professional | | $96.05 | $118.89 | $163.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.95 / $147.40 / $208.70
| Professional | | $115.95 | $147.40 | $208.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $103.62 / $144.19
| Professional | | $1.37 | $103.62 | $144.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.37 / $101.78 / $129.53
| Professional | | $1.37 | $101.78 | $129.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.45 / $128.11 / $199.08
| Professional | | $91.45 | $128.11 | $199.08 |