- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.42 / $117.09 / $198.12
| Professional | | $100.42 | $117.09 | $198.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.54 / $220.73 / $373.32
| Professional | | $63.54 | $220.73 | $373.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.58 / $150.11 / $427.57
| Professional | | $65.58 | $150.11 | $427.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.58 / $221.07 / $524.36
| Professional | | $153.58 | $221.07 | $524.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.44 / $179.00 / $292.66
| Professional | | $76.44 | $179.00 | $292.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.80 / $156.33 / $224.22
| Professional | | $112.80 | $156.33 | $224.22 |