- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.35 / $64.48 / $201.78
| Professional | | $47.35 | $64.48 | $201.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.87 / $239.14 / $428.37
| Professional | | $202.87 | $239.14 | $428.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.22 / $127.51 / $386.22
| Professional | | $78.22 | $127.51 | $386.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.66 / $194.63 / $342.19
| Professional | | $79.66 | $194.63 | $342.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.81 / $242.49 / $572.30
| Professional | | $74.81 | $242.49 | $572.30 |