- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.11 / $230.35 / $374.25
| Professional | | $140.11 | $230.35 | $374.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $156.81 / $254.60
| Professional | | $100.00 | $156.81 | $254.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.77 / $253.93 / $448.64
| Professional | | $148.77 | $253.93 | $448.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.17 / $186.80 / $290.82
| Professional | | $77.17 | $186.80 | $290.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.22 / $200.84 / $328.22
| Professional | | $35.22 | $200.84 | $328.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.93 / $292.49 / $538.15
| Professional | | $200.93 | $292.49 | $538.15 |