- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.97 / $139.87 / $686.00
| Professional | | $116.97 | $139.87 | $686.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.48 / $215.59 / $292.67
| Professional | | $126.48 | $215.59 | $292.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.00 / $300.33 / $454.24
| Professional | | $214.00 | $300.33 | $454.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.26 / $320.43 / $961.60
| Professional | | $190.26 | $320.43 | $961.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.00 / $312.05 / $398.89
| Professional | | $249.00 | $312.05 | $398.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.08 / $320.43 / $409.78
| Professional | | $179.08 | $320.43 | $409.78 |