- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.82 / $238.52 / $264.58
| Professional | | $107.82 | $238.52 | $264.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.00 / $431.00 / $431.00
| Professional | | $431.00 | $431.00 | $431.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.55 / $142.16 / $387.73
| Professional | | $59.55 | $142.16 | $387.73 |
- 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
- $87.34 / $154.03 / $363.46
| Professional | | $87.34 | $154.03 | $363.46 |