- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.07 / $196.31 / $371.41
| Professional | | $35.07 | $196.31 | $371.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.50 / $323.58 / $842.01
| Professional | | $274.50 | $323.58 | $842.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.80 / $195.28 / $842.01
| Professional | | $51.80 | $195.28 | $842.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.66 / $315.99 / $842.01
| Professional | | $59.66 | $315.99 | $842.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.47 / $325.61 / $1,033.47
| Professional | | $267.47 | $325.61 | $1,033.47 |