- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.46 / $126.70 / $645.05
| Professional | | $124.46 | $126.70 | $645.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.18 / $144.16 / $207.49
| Professional | | $119.18 | $144.16 | $207.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.34 / $154.44 / $225.38
| Professional | | $100.34 | $154.44 | $225.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.76 / $140.83 / $214.31
| Professional | | $1.76 | $140.83 | $214.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.32 / $116.78 / $183.69
| Professional | | $1.32 | $116.78 | $183.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.85 / $145.08 / $214.10
| Professional | | $122.85 | $145.08 | $214.10 |