- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.41 / $166.34 / $309.87
| Professional | | $133.41 | $166.34 | $309.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.07 / $147.77 / $1,931.00
| Professional | | $113.07 | $147.77 | $1,931.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.40 / $236.05 / $635.51
| Professional | | $131.40 | $236.05 | $635.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $267.02 / $296.77 / $598.42
| Professional | | $267.02 | $296.77 | $598.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.09 / $236.05 / $727.46
| Professional | | $160.09 | $236.05 | $727.46 |