- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.22 / $221.24 / $379.33
| Professional | | $117.22 | $221.24 | $379.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.00 / $136.38 / $271.70
| Professional | | $104.00 | $136.38 | $271.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.07 / $240.84 / $474.23
| Professional | | $128.07 | $240.84 | $474.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.74 / $141.36 / $172.60
| Professional | | $139.74 | $141.36 | $172.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.92 / $204.79 / $346.67
| Professional | | $31.92 | $204.79 | $346.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.25 / $322.43 / $682.56
| Professional | | $220.25 | $322.43 | $682.56 |