- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.03 / $129.88 / $197.58
| Professional | | $37.03 | $129.88 | $197.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.77 / $91.68 / $224.12
| Professional | | $42.77 | $91.68 | $224.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.20 / $129.52 / $295.50
| Professional | | $42.20 | $129.52 | $295.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.96 / $301.58 / $1,196.56
| Professional | | $135.96 | $301.58 | $1,196.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.67 / $203.15 / $358.17
| Professional | | $127.67 | $203.15 | $358.17 |