- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.94 / $74.66 / $186.61
| Professional | | $65.94 | $74.66 | $186.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.46 / $103.51 / $236.23
| Professional | | $61.46 | $103.51 | $236.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.59 / $161.57 / $350.04
| Professional | | $68.59 | $161.57 | $350.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.65 / $144.50 / $289.26
| Professional | | $62.65 | $144.50 | $289.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.94 / $74.66 / $186.61
| Professional | | $65.94 | $74.66 | $186.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.88 / $170.85 / $313.52
| Professional | | $132.88 | $170.85 | $313.52 |