- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $141.25 / $295.12
| Professional | | $112.20 | $141.25 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $177.83 / $363.08
| Professional | | $114.82 | $177.83 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $87.10 / $147.91
| Professional | | $81.28 | $87.10 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $162.18
| Professional | | $32.36 | $33.11 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $154.88 / $269.15
| Professional | | $107.15 | $154.88 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $114.82
| Professional | | $100.00 | $100.00 | $114.82 |