- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.14 / $141.59 / $190.78
| Professional | | $119.14 | $141.59 | $190.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.69 / $223.18 / $377.00
| Professional | | $151.69 | $223.18 | $377.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.37 / $210.34 / $505.00
| Professional | | $124.37 | $210.34 | $505.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.19 / $290.98 / $1,760.08
| Professional | | $142.19 | $290.98 | $1,760.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.46 / $248.17 / $438.18
| Professional | | $136.46 | $248.17 | $438.18 |