- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.40 / $150.76 / $216.89
| Professional | | $128.40 | $150.76 | $216.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.10 / $286.44 / $308.37
| Professional | | $232.10 | $286.44 | $308.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.68 / $271.35 / $357.00
| Professional | | $150.68 | $271.35 | $357.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.69 / $260.48 / $886.02
| Professional | | $141.69 | $260.48 | $886.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.46 / $191.94 / $318.08
| Professional | | $115.46 | $191.94 | $318.08 |