- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.44 / $188.43 / $350.19
| Professional | | $130.44 | $188.43 | $350.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.91 / $264.70 / $600.00
| Professional | | $145.91 | $264.70 | $600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.52 / $373.49 / $492.87
| Professional | | $275.52 | $373.49 | $492.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.31 / $244.54 / $408.65
| Professional | | $135.31 | $244.54 | $408.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.74 / $255.22 / $546.32
| Professional | | $152.74 | $255.22 | $546.32 |