- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.90 / $140.24 / $269.25
| Professional | | $114.90 | $140.24 | $269.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.58 / $121.84 / $1,030.00
| Professional | | $118.58 | $121.84 | $1,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.65 / $226.45 / $567.10
| Professional | | $110.65 | $226.45 | $567.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.36 / $249.13 / $516.90
| Professional | | $230.36 | $249.13 | $516.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.78 / $239.65 / $628.35
| Professional | | $172.78 | $239.65 | $628.35 |