- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.74 / $246.53 / $848.64
| Professional | | $145.74 | $246.53 | $848.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.19 / $281.50 / $460.00
| Professional | | $186.19 | $281.50 | $460.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.98 / $169.75 / $229.06
| Professional | | $25.98 | $169.75 | $229.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.27 / $367.64 / $576.47
| Professional | | $210.27 | $367.64 | $576.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.60 / $265.32 / $447.65
| Professional | | $216.60 | $265.32 | $447.65 |