- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.86 / $223.94 / $226.97
| Professional | | $38.86 | $223.94 | $226.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.70 / $211.83 / $242.10
| Professional | | $33.70 | $211.83 | $242.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.88 / $165.78 / $743.64
| Professional | | $30.88 | $165.78 | $743.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.62 / $363.14 / $453.93
| Professional | | $302.62 | $363.14 | $453.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16.77 / $133.15 / $203.78
| Professional | | $16.77 | $133.15 | $203.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.31 / $240.58 / $240.58
| Professional | | $151.31 | $240.58 | $240.58 |