- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.62 / $175.32 / $191.94
| Professional | | $158.62 | $175.32 | $191.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.03 / $184.39 / $660.00
| Professional | | $177.03 | $184.39 | $660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.61 / $234.80 / $508.96
| Professional | | $158.61 | $234.80 | $508.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.96 / $432.78 / $432.78
| Professional | | $356.96 | $432.78 | $432.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.83 / $346.55 / $523.98
| Professional | | $137.83 | $346.55 | $523.98 |