- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.31 / $239.27 / $320.95
| Professional | | $130.31 | $239.27 | $320.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.59 / $126.24 / $1,030.00
| Professional | | $108.59 | $126.24 | $1,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.78 / $239.22 / $575.72
| Professional | | $122.78 | $239.22 | $575.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.26 / $257.12 / $540.29
| Professional | | $244.26 | $257.12 | $540.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.46 / $249.08 / $656.79
| Professional | | $177.46 | $249.08 | $656.79 |