- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $316.23 / $380.19
| Professional | | $302.00 | $316.23 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $107.15 / $123.03
| Professional | | $91.20 | $107.15 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $138.04
| Professional | | $109.65 | $109.65 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $758.58
| Professional | | $758.58 | $758.58 | $758.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $354.81 / $398.11
| Professional | | $316.23 | $354.81 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $85.11 / $758.58
| Professional | | $77.62 | $85.11 | $758.58 |