- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.58 / $111.79 / $124.24
| Professional | | $45.58 | $111.79 | $124.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.92 / $140.57 / $173.62
| Professional | | $118.92 | $140.57 | $173.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.86 / $70.00 / $161.62
| Professional | | $31.86 | $70.00 | $161.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.31 / $167.17 / $240.61
| Professional | | $139.31 | $167.17 | $240.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.47 / $104.19 / $177.00
| Professional | | $52.47 | $104.19 | $177.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.47 / $174.34 / $198.92
| Professional | | $111.47 | $174.34 | $198.92 |