- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.71 / $66.20 / $83.68
| Professional | | $44.71 | $66.20 | $83.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.23 / $133.59 / $210.98
| Professional | | $103.23 | $133.59 | $210.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.29 / $143.87 / $272.23
| Professional | | $73.29 | $143.87 | $272.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.56 / $144.50 / $1,641.00
| Professional | | $81.56 | $144.50 | $1,641.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.56 / $144.36 / $179.43
| Professional | | $81.56 | $144.36 | $179.43 |