- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.73 / $100.20 / $109.77
| Professional | | $83.73 | $100.20 | $109.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $56.29 / $91.47 / $91.47
| Professional | | $56.29 | $91.47 | $91.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.69 / $275.08 / $585.05
| Professional | | $127.69 | $275.08 | $585.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.72 / $204.06 / $434.36
| Professional | | $140.72 | $204.06 | $434.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $140.72 / $246.42
| Professional | | $50.00 | $140.72 | $246.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.04 / $147.63 / $226.44
| Professional | | $110.04 | $147.63 | $226.44 |