- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.89 / $158.40 / $190.64
| Professional | | $57.89 | $158.40 | $190.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.79 / $223.15 / $573.29
| Professional | | $183.79 | $223.15 | $573.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.97 / $166.35 / $455.03
| Professional | | $59.97 | $166.35 | $455.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.56 / $167.93 / $455.03
| Professional | | $80.56 | $167.93 | $455.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.72 / $217.67 / $632.79
| Professional | | $156.72 | $217.67 | $632.79 |