- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.11 / $163.80 / $338.47
| Professional | | $130.11 | $163.80 | $338.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.00 / $227.00 / $227.00
| Professional | | $227.00 | $227.00 | $227.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.47 / $246.70 / $344.32
| Professional | | $165.47 | $246.70 | $344.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.77 / $193.26 / $374.24
| Professional | | $152.77 | $193.26 | $374.24 |