- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.64 / $56.50 / $137.93
| Professional | | $19.64 | $56.50 | $137.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.77 / $308.85 / $308.85
| Professional | | $154.77 | $308.85 | $308.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $97.85 / $211.15
| Professional | | $36.31 | $97.85 | $211.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.49 / $113.08 / $215.00
| Professional | | $40.49 | $113.08 | $215.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.41 / $118.83 / $202.12
| Professional | | $85.41 | $118.83 | $202.12 |