- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.06 / $104.82 / $162.75
| Professional | | $64.06 | $104.82 | $162.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.87 / $184.40 / $565.05
| Professional | | $151.87 | $184.40 | $565.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.31 / $180.03 / $438.42
| Professional | | $87.31 | $180.03 | $438.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.38 / $184.32 / $438.42
| Professional | | $104.38 | $184.32 | $438.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.71 / $174.29 / $506.66
| Professional | | $130.71 | $174.29 | $506.66 |