- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $229.09 / $562.34
| Professional | | $112.20 | $229.09 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $302.00 / $302.00
| Professional | | $257.04 | $302.00 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $269.15 / $812.83
| Professional | | $144.54 | $269.15 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $295.12 / $549.54
| Professional | | $223.87 | $295.12 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $234.42 / $467.74
| Professional | | $123.03 | $234.42 | $467.74 |