- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.57 / $85.55 / $107.28
| Professional | | $62.57 | $85.55 | $107.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.88 / $108.54 / $138.28
| Professional | | $73.88 | $108.54 | $138.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.24 / $209.35 / $610.72
| Professional | | $106.24 | $209.35 | $610.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.30 / $145.56 / $199.22
| Professional | | $105.30 | $145.56 | $199.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.39 / $144.69 / $194.07
| Professional | | $98.39 | $144.69 | $194.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.24 / $175.27 / $271.88
| Professional | | $106.24 | $175.27 | $271.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.90 / $148.00 / $217.60
| Professional | | $120.90 | $148.00 | $217.60 |