- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.66 / $97.19 / $131.78
| Professional | | $53.66 | $97.19 | $131.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.87 / $161.34 / $453.05
| Professional | | $132.87 | $161.34 | $453.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.03 / $131.26 / $359.04
| Professional | | $52.03 | $131.26 | $359.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.09 / $138.21 / $359.04
| Professional | | $70.09 | $138.21 | $359.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.24 / $144.51 / $511.42
| Professional | | $117.24 | $144.51 | $511.42 |