- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.28 / $97.60 / $224.57
| Professional | | $52.28 | $97.60 | $224.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.37 / $129.22 / $207.26
| Professional | | $71.37 | $129.22 | $207.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.02 / $129.72 / $287.06
| Professional | | $70.02 | $129.72 | $287.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.84 / $142.94 / $283.14
| Professional | | $75.84 | $142.94 | $283.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.28 / $104.71 / $224.57
| Professional | | $52.28 | $104.71 | $224.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.65 / $196.46 / $282.01
| Professional | | $116.65 | $196.46 | $282.01 |