- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.08 / $274.56 / $483.61
| Professional | | $143.08 | $274.56 | $483.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $213.23
| Professional | | $213.23 | $213.23 | $213.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $476.39 / $577.27
| Professional | | $60.00 | $476.39 | $577.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.74 / $410.03 / $414.62
| Professional | | $325.74 | $410.03 | $414.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.53 / $221.62 / $369.37
| Professional | | $173.53 | $221.62 | $369.37 |