- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.06 / $103.20 / $151.91
| Professional | | $53.06 | $103.20 | $151.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.84 / $147.93 / $427.02
| Professional | | $121.84 | $147.93 | $427.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.70 / $133.51 / $338.52
| Professional | | $55.70 | $133.51 | $338.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.80 / $138.91 / $338.52
| Professional | | $74.80 | $138.91 | $338.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.21 / $128.28 / $453.75
| Professional | | $114.21 | $128.28 | $453.75 |