- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.73 / $118.89 / $354.67
| Professional | | $78.73 | $118.89 | $354.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.74 / $75.39 / $317.29
| Professional | | $38.74 | $75.39 | $317.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.57 / $100.92 / $354.98
| Professional | | $36.57 | $100.92 | $354.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.46 / $196.63 / $1,098.48
| Professional | | $117.46 | $196.63 | $1,098.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.60 / $121.31 / $223.51
| Professional | | $48.60 | $121.31 | $223.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.67 / $98.54 / $293.60
| Professional | | $74.67 | $98.54 | $293.60 |