- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.57 / $60.15 / $104.12
| Professional | | $47.57 | $60.15 | $104.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.05 / $224.53 / $329.16
| Professional | | $199.05 | $224.53 | $329.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.12 / $112.06 / $201.42
| Professional | | $67.12 | $112.06 | $201.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.75 / $116.19 / $201.42
| Professional | | $67.75 | $116.19 | $201.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.82 / $134.77 / $367.76
| Professional | | $119.82 | $134.77 | $367.76 |