- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.31 / $97.70 / $240.36
| Professional | | $69.31 | $97.70 | $240.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.00 / $413.59 / $1,201.93
| Professional | | $317.00 | $413.59 | $1,201.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.23 / $225.24 / $593.01
| Professional | | $102.23 | $225.24 | $593.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.14 / $225.24 / $593.01
| Professional | | $107.14 | $225.24 | $593.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.53 / $372.46 / $1,475.24
| Professional | | $236.53 | $372.46 | $1,475.24 |