- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.78 / $176.95 / $220.12
| Professional | | $166.78 | $176.95 | $220.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.78 / $50.00 / $265.58
| Professional | | $27.78 | $50.00 | $265.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.44 / $204.02 / $333.33
| Professional | | $149.44 | $204.02 | $333.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.40 / $206.30 / $1,103.57
| Professional | | $143.40 | $206.30 | $1,103.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.94 / $196.55 / $335.11
| Professional | | $132.94 | $196.55 | $335.11 |