- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.15 / $142.90 / $150.57
| Professional | | $101.15 | $142.90 | $150.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.36 / $161.69 / $207.16
| Professional | | $96.36 | $161.69 | $207.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.22 / $165.29 / $188.90
| Professional | | $150.22 | $165.29 | $188.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $132.60 / $166.82
| Professional | | $32.34 | $132.60 | $166.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.40 / $152.24 / $173.65
| Professional | | $129.40 | $152.24 | $173.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.03 / $143.57 / $189.00
| Professional | | $111.03 | $143.57 | $189.00 |