- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.70 / $315.17 / $1,090.72
| Professional | | $125.70 | $315.17 | $1,090.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.34 / $131.40 / $870.69
| Professional | | $90.34 | $131.40 | $870.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.51 / $169.64 / $333.77
| Professional | | $121.51 | $169.64 | $333.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.94 / $168.02 / $297.14
| Professional | | $145.94 | $168.02 | $297.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.94 / $168.02 / $268.99
| Professional | | $145.94 | $168.02 | $268.99 |