- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.74 / $304.32 / $503.80
| Professional | | $189.74 | $304.32 | $503.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.08 / $338.64 / $449.51
| Professional | | $210.08 | $338.64 | $449.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.00 / $339.50 / $553.30
| Professional | | $204.00 | $339.50 | $553.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.42 / $303.02 / $508.26
| Professional | | $6.42 | $303.02 | $508.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.30 / $205.91 / $322.68
| Professional | | $3.30 | $205.91 | $322.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.57 / $396.62 / $728.34
| Professional | | $34.57 | $396.62 | $728.34 |