- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.54 / $91.20 / $194.98
| Professional | | $57.54 | $91.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.23 / $102.33 / $138.04
| Professional | | $56.23 | $102.33 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.44 / $107.15 / $204.17
| Professional | | $72.44 | $107.15 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $100.00 / $165.96
| Professional | | $75.86 | $100.00 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $91.20 / $194.98
| Professional | | $63.10 | $91.20 | $194.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $100.00 / $141.25
| Professional | | $74.13 | $100.00 | $141.25 |