- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.30 / $196.53 / $244.03
| Professional | | $130.30 | $196.53 | $244.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.27 / $346.03 / $528.34
| Professional | | $268.27 | $346.03 | $528.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.60 / $418.79 / $716.26
| Professional | | $237.60 | $418.79 | $716.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.94 / $447.67 / $1,710.56
| Professional | | $247.94 | $447.67 | $1,710.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.15 / $360.60 / $638.77
| Professional | | $244.15 | $360.60 | $638.77 |