- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.29 / $227.44 / $316.43
| Professional | | $82.29 | $227.44 | $316.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.53 / $211.53 / $238.82
| Professional | | $211.53 | $211.53 | $238.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.75 / $236.64 / $341.17
| Professional | | $172.75 | $236.64 | $341.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.96 / $257.88 / $864.96
| Professional | | $118.96 | $257.88 | $864.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.22 / $103.69 / $208.00
| Professional | | $58.22 | $103.69 | $208.00 |