- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.31 / $174.58 / $506.22
| Professional | | $97.31 | $174.58 | $506.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.20 / $405.91 / $660.71
| Professional | | $377.20 | $405.91 | $660.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.08 / $181.89 / $311.32
| Professional | | $134.08 | $181.89 | $311.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.00 / $183.83 / $307.70
| Professional | | $110.00 | $183.83 | $307.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.05 / $244.41 / $740.68
| Professional | | $206.05 | $244.41 | $740.68 |