- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.93 / $78.77 / $138.96
| Professional | | $50.93 | $78.77 | $138.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.09 / $157.94 / $703.12
| Professional | | $130.09 | $157.94 | $703.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.11 / $87.59 / $227.26
| Professional | | $53.11 | $87.59 | $227.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.55 / $115.55 / $227.26
| Professional | | $71.55 | $115.55 | $227.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.70 / $110.78 / $322.05
| Professional | | $80.70 | $110.78 | $322.05 |