- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.43 / $135.12 / $240.11
| Professional | | $118.43 | $135.12 | $240.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.69 / $150.77 / $660.00
| Professional | | $147.69 | $150.77 | $660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.50 / $218.52 / $499.77
| Professional | | $122.50 | $218.52 | $499.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.83 / $537.14 / $537.14
| Professional | | $235.83 | $537.14 | $537.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.56 / $249.93 / $696.58
| Professional | | $170.56 | $249.93 | $696.58 |