- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.17 / $264.70 / $373.38
| Professional | | $194.17 | $264.70 | $373.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.00 / $203.11 / $306.89
| Professional | | $152.00 | $203.11 | $306.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $57.13 / $75.61 / $307.08
| Professional | | $57.13 | $75.61 | $307.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.02 / $305.14 / $716.08
| Professional | | $199.02 | $305.14 | $716.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $37.17 / $92.45
| Professional | | $32.34 | $37.17 | $92.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.53 / $323.27 / $449.18
| Professional | | $222.53 | $323.27 | $449.18 |