- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.56 / $77.09 / $293.58
| Professional | | $35.56 | $77.09 | $293.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.92 / $253.22 / $503.16
| Professional | | $121.92 | $253.22 | $503.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.32 / $500.74 / $1,063.73
| Professional | | $122.32 | $500.74 | $1,063.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.08 / $408.50 / $693.79
| Professional | | $344.08 | $408.50 | $693.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $37.29 / $63.33 / $523.55
| Professional | | $37.29 | $63.33 | $523.55 |