- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.72 / $61.50 / $141.50
| Professional | | $45.72 | $61.50 | $141.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.78 / $159.78 / $445.97
| Professional | | $159.78 | $159.78 | $445.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.91 / $132.86 / $275.72
| Professional | | $59.91 | $132.86 | $275.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.91 / $153.88 / $301.01
| Professional | | $59.91 | $153.88 | $301.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.54 / $173.18 / $503.45
| Professional | | $142.54 | $173.18 | $503.45 |