- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $128.82 / $239.88
| Professional | | $85.11 | $128.82 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $162.18 / $309.03
| Professional | | $100.00 | $162.18 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $112.20 / $144.54
| Professional | | $107.15 | $112.20 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $181.97
| Professional | | $32.36 | $33.11 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $144.54 / $257.04
| Professional | | $87.10 | $144.54 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $112.20 / $151.36
| Professional | | $74.13 | $112.20 | $151.36 |