- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.42 / $195.55 / $581.00
| Professional | | $121.42 | $195.55 | $581.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.30 / $208.78 / $307.58
| Professional | | $135.30 | $208.78 | $307.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.10 / $185.19 / $314.89
| Professional | | $97.10 | $185.19 | $314.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.68 / $207.30 / $315.06
| Professional | | $169.68 | $207.30 | $315.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.72 / $363.72 / $363.72
| Professional | | $363.72 | $363.72 | $363.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.29 / $181.72 / $317.41
| Professional | | $136.29 | $181.72 | $317.41 |