- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $181.97 / $363.08
| Professional | | $104.71 | $181.97 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $213.80 / $354.81
| Professional | | $128.82 | $213.80 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $229.09
| Professional | | $32.36 | $33.11 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $199.53 / $363.08
| Professional | | $131.83 | $199.53 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $194.98 / $457.09
| Professional | | $104.71 | $194.98 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $223.87 / $346.74
| Professional | | $112.20 | $223.87 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $186.21 / $302.00
| Professional | | $100.00 | $186.21 | $302.00 |