- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.54 / $226.10 / $433.21
| Professional | | $141.54 | $226.10 | $433.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.00 / $235.00 / $670.75
| Professional | | $235.00 | $235.00 | $670.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.63 / $232.78 / $396.34
| Professional | | $159.63 | $232.78 | $396.34 |
- 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
- $185.02 / $264.11 / $537.21
| Professional | | $185.02 | $264.11 | $537.21 |