- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.64 / $126.91 / $194.69
| Professional | | $72.64 | $126.91 | $194.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.22 / $189.68 / $559.72
| Professional | | $156.22 | $189.68 | $559.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.66 / $155.83 / $426.78
| Professional | | $73.66 | $155.83 | $426.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.06 / $196.09 / $426.78
| Professional | | $100.06 | $196.09 | $426.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.32 / $180.22 / $637.79
| Professional | | $155.32 | $180.22 | $637.79 |