- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.64 / $132.71 / $504.00
| Professional | | $109.64 | $132.71 | $504.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.78 / $147.11 / $223.94
| Professional | | $84.78 | $147.11 | $223.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.13 / $140.37 / $224.05
| Professional | | $98.13 | $140.37 | $224.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.20 / $139.25 / $209.54
| Professional | | $102.20 | $139.25 | $209.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.73 / $132.62 / $198.93
| Professional | | $114.73 | $132.62 | $198.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.80 / $151.59 / $261.80
| Professional | | $108.80 | $151.59 | $261.80 |