- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.82 / $119.07 / $196.10
| Professional | | $62.82 | $119.07 | $196.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.88 / $227.58 / $509.78
| Professional | | $131.88 | $227.58 | $509.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.75 / $231.32 / $580.60
| Professional | | $94.75 | $231.32 | $580.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.77 / $257.70 / $523.61
| Professional | | $138.77 | $257.70 | $523.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.30 / $303.83 / $929.00
| Professional | | $152.30 | $303.83 | $929.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.30 / $260.17 / $537.62
| Professional | | $152.30 | $260.17 | $537.62 |