- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $234.42 / $316.23
| Professional | | $75.86 | $234.42 | $316.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.79 / $177.83 / $234.42
| Professional | | $70.79 | $177.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $114.82 / $138.04
| Professional | | $75.86 | $114.82 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $338.84 / $1,412.54
| Professional | | $104.71 | $338.84 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $204.17 / $457.09
| Professional | | $85.11 | $204.17 | $457.09 |