- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.30 / $159.52 / $196.93
| Professional | | $115.30 | $159.52 | $196.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.03 / $137.12 / $235.06
| Professional | | $101.03 | $137.12 | $235.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.24 / $145.63 / $277.51
| Professional | | $123.24 | $145.63 | $277.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.32 / $109.92 / $110.72
| Professional | | $108.32 | $109.92 | $110.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.66 / $167.76 / $260.24
| Professional | | $115.66 | $167.76 | $260.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.00 / $108.00 / $108.00
| Professional | | $108.00 | $108.00 | $108.00 |