- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.17 / $100.32 / $142.30
| Professional | | $94.17 | $100.32 | $142.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.12 / $152.03 / $204.81
| Professional | | $90.12 | $152.03 | $204.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.78 / $206.58 / $253.58
| Professional | | $121.78 | $206.58 | $253.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.56 / $188.01 / $3,176.85
| Professional | | $113.56 | $188.01 | $3,176.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.27 / $196.19 / $262.75
| Professional | | $152.27 | $196.19 | $262.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.71 / $175.60 / $302.30
| Professional | | $100.71 | $175.60 | $302.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.74 / $188.01 / $241.08
| Professional | | $105.74 | $188.01 | $241.08 |