- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $169.82 / $602.56
| Professional | | $93.33 | $169.82 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $426.58 / $660.69
| Professional | | $380.19 | $426.58 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $181.97 / $309.03
| Professional | | $134.90 | $181.97 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $660.69
| Professional | | $302.00 | $302.00 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $213.80 / $426.58
| Professional | | $107.15 | $213.80 | $426.58 |