- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.74 / $102.13 / $166.16
| Professional | | $95.74 | $102.13 | $166.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.10 / $135.10 / $135.10
| Professional | | $135.10 | $135.10 | $135.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.75 / $103.66 / $182.33
| Professional | | $96.75 | $103.66 | $182.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.12 / $177.21 / $252.53
| Professional | | $129.12 | $177.21 | $252.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.58 / $153.02 / $292.98
| Professional | | $109.58 | $153.02 | $292.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.33 / $125.33 / $125.33
| Professional | | $125.33 | $125.33 | $125.33 |