- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.34 / $141.53 / $246.23
| Professional | | $101.34 | $141.53 | $246.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.62 / $138.69 / $202.00
| Professional | | $106.62 | $138.69 | $202.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.59 / $181.33 / $307.00
| Professional | | $124.59 | $181.33 | $307.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.71 / $235.25 / $1,166.24
| Professional | | $149.71 | $235.25 | $1,166.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.71 / $194.45 / $333.06
| Professional | | $141.71 | $194.45 | $333.06 |