- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.64 / $241.16 / $350.00
| Professional | | $38.64 | $241.16 | $350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.08 / $561.60 / $615.73
| Professional | | $467.08 | $561.60 | $615.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.77 / $555.86 / $835.19
| Professional | | $374.77 | $555.86 | $835.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.78 / $74.92 / $1,246.66
| Professional | | $40.78 | $74.92 | $1,246.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.89 / $81.01 / $438.22
| Professional | | $43.89 | $81.01 | $438.22 |