- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.77 / $130.69 / $157.65
| Professional | | $47.77 | $130.69 | $157.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.97 / $184.52 / $462.91
| Professional | | $151.97 | $184.52 | $462.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.81 / $133.81 / $367.40
| Professional | | $49.81 | $133.81 | $367.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.84 / $138.84 / $367.40
| Professional | | $66.84 | $138.84 | $367.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.66 / $179.55 / $521.96
| Professional | | $134.66 | $179.55 | $521.96 |