- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $138.04 / $223.87
| Professional | | $112.20 | $138.04 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $173.78 / $263.03
| Professional | | $112.20 | $173.78 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $213.80
| Professional | | $32.36 | $33.11 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $302.00
| Professional | | $120.23 | $173.78 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $194.98 / $263.03
| Professional | | $117.49 | $194.98 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $190.55 / $275.42
| Professional | | $147.91 | $190.55 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $229.09
| Professional | | $109.65 | $151.36 | $229.09 |