- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.96 / $240.98 / $337.54
| Professional | | $115.96 | $240.98 | $337.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.83 / $225.75 / $314.31
| Professional | | $115.83 | $225.75 | $314.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.34 / $209.39 / $366.03
| Professional | | $102.34 | $209.39 | $366.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.02 / $131.08 / $265.08
| Professional | | $2.02 | $131.08 | $265.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.27 / $89.72 / $182.56
| Professional | | $1.27 | $89.72 | $182.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.40 / $254.93 / $434.08
| Professional | | $214.40 | $254.93 | $434.08 |