- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.75 / $52.64 / $148.47
| Professional | | $41.75 | $52.64 | $148.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.81 / $337.81 / $337.81
| Professional | | $337.81 | $337.81 | $337.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.53 / $104.99 / $225.81
| Professional | | $59.53 | $104.99 | $225.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.10 / $121.36 / $225.81
| Professional | | $60.10 | $121.36 | $225.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.34 / $198.16 / $412.32
| Professional | | $134.34 | $198.16 | $412.32 |