- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.30 / $194.14 / $1,095.80
| Professional | | $118.30 | $194.14 | $1,095.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.26 / $293.76 / $358.53
| Professional | | $227.26 | $293.76 | $358.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $90.43 / $194.23
| Professional | | $32.34 | $90.43 | $194.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.26 / $277.35 / $358.53
| Professional | | $227.26 | $277.35 | $358.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.34 / $200.32 / $379.31
| Professional | | $165.34 | $200.32 | $379.31 |