- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.34 / $91.88 / $151.41
| Professional | | $65.34 | $91.88 | $151.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.79 / $314.85 / $472.99
| Professional | | $298.79 | $314.85 | $472.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.77 / $147.44 / $273.68
| Professional | | $90.77 | $147.44 | $273.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.77 / $147.44 / $298.35
| Professional | | $90.77 | $147.44 | $298.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.83 / $171.89 / $499.70
| Professional | | $158.83 | $171.89 | $499.70 |