- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $123.03 / $208.93
| Professional | | $97.72 | $123.03 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $109.65 / $158.49
| Professional | | $97.72 | $109.65 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $120.23 / $223.87
| Professional | | $89.13 | $120.23 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $151.36
| Professional | | $75.86 | $100.00 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $117.49 / $213.80
| Professional | | $87.10 | $117.49 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $114.82 / $138.04
| Professional | | $77.62 | $114.82 | $138.04 |