- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.10 / $128.77 / $210.16
| Professional | | $98.10 | $128.77 | $210.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $120.98 / $183.25
| Professional | | $100.00 | $120.98 | $183.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.56 / $163.16 / $283.57
| Professional | | $117.56 | $163.16 | $283.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.68 / $127.68 / $127.68
| Professional | | $127.68 | $127.68 | $127.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.22 / $187.09 / $290.58
| Professional | | $137.22 | $187.09 | $290.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.06 / $148.71 / $322.60
| Professional | | $114.06 | $148.71 | $322.60 |