- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.80 / $227.06 / $467.27
| Professional | | $132.80 | $227.06 | $467.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $293.00
| Professional | | $293.00 | $293.00 | $293.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.66 / $243.57 / $403.00
| Professional | | $152.66 | $243.57 | $403.00 |
- 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
- $199.62 / $287.44 / $529.55
| Professional | | $199.62 | $287.44 | $529.55 |