- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.59 / $299.37 / $724.31
| Professional | | $183.59 | $299.37 | $724.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.00 / $362.00 / $362.00
| Professional | | $362.00 | $362.00 | $362.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.69 / $333.92 / $598.47
| Professional | | $192.69 | $333.92 | $598.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.27 / $358.35 / $726.36
| Professional | | $276.27 | $358.35 | $726.36 |