- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $151.36 / $223.87
| Professional | | $120.23 | $151.36 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $275.42 / $302.00
| Professional | | $204.17 | $275.42 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $234.42 / $354.81
| Professional | | $131.83 | $234.42 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $194.98 / $891.25
| Professional | | $131.83 | $194.98 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $186.21 / $309.03
| Professional | | $125.89 | $186.21 | $309.03 |