- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.93 / $193.13 / $222.76
| Professional | | $33.93 | $193.13 | $222.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.34 / $170.50 / $170.50
| Professional | | $152.34 | $170.50 | $170.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.47 / $212.47 / $230.54
| Professional | | $212.47 | $212.47 | $230.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.22 / $49.60 / $89.48
| Professional | | $41.22 | $49.60 | $89.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.93 / $186.31 / $222.76
| Professional | | $33.93 | $186.31 | $222.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.06 / $254.85 / $451.14
| Professional | | $68.06 | $254.85 | $451.14 |