- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.06 / $73.20 / $396.76
| Professional | | $64.06 | $73.20 | $396.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.20 / $71.64 / $147.58
| Professional | | $71.20 | $71.64 | $147.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.81 / $118.92 / $183.93
| Professional | | $71.81 | $118.92 | $183.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.33 / $100.74 / $148.15
| Professional | | $3.33 | $100.74 | $148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.33 / $68.05 / $109.98
| Professional | | $3.33 | $68.05 | $109.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.56 / $125.91 / $210.29
| Professional | | $70.56 | $125.91 | $210.29 |