- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.01 / $72.52 / $405.28
| Professional | | $38.01 | $72.52 | $405.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.63 / $297.00 / $521.27
| Professional | | $152.63 | $297.00 | $521.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.19 / $373.61 / $452.86
| Professional | | $267.19 | $373.61 | $452.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $152.51 / $205.45
| Professional | | $30.00 | $152.51 | $205.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.36 / $333.82 / $362.86
| Professional | | $167.36 | $333.82 | $362.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.68 / $54.24 / $74.18
| Professional | | $40.68 | $54.24 | $74.18 |