- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.48 / $115.19 / $153.05
| Professional | | $64.48 | $115.19 | $153.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.13 / $188.37 / $525.46
| Professional | | $155.13 | $188.37 | $525.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.70 / $147.86 / $406.03
| Professional | | $65.70 | $147.86 | $406.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.30 / $176.32 / $406.03
| Professional | | $89.30 | $176.32 | $406.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.53 / $168.76 / $597.26
| Professional | | $137.53 | $168.76 | $597.26 |