- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.89 / $127.72 / $151.10
| Professional | | $102.89 | $127.72 | $151.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.45 / $155.41 / $261.26
| Professional | | $94.45 | $155.41 | $261.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.13 / $186.60 / $293.49
| Professional | | $115.13 | $186.60 | $293.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.13 / $178.25 / $356.19
| Professional | | $108.13 | $178.25 | $356.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.74 / $168.96 / $272.64
| Professional | | $109.74 | $168.96 | $272.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.56 / $103.87 / $148.35
| Professional | | $86.56 | $103.87 | $148.35 |