- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.15 / $232.46 / $413.85
| Professional | | $211.15 | $232.46 | $413.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.86 / $235.86 / $660.00
| Professional | | $235.86 | $235.86 | $660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.52 / $374.08 / $977.02
| Professional | | $210.52 | $374.08 | $977.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.59 / $926.61 / $926.61
| Professional | | $401.59 | $926.61 | $926.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.24 / $459.86 / $1,070.77
| Professional | | $327.24 | $459.86 | $1,070.77 |