- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.78 / $80.09 / $157.02
| Professional | | $47.78 | $80.09 | $157.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.28 / $188.12 / $222.34
| Professional | | $176.28 | $188.12 | $222.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.08 / $148.66 / $240.98
| Professional | | $104.08 | $148.66 | $240.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.20 / $151.26 / $710.00
| Professional | | $81.20 | $151.26 | $710.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.20 / $140.02 / $201.58
| Professional | | $81.20 | $140.02 | $201.58 |