- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.31 / $146.58 / $159.58
| Professional | | $116.31 | $146.58 | $159.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.11 / $147.00 / $201.85
| Professional | | $109.11 | $147.00 | $201.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.13 / $174.10 / $232.17
| Professional | | $116.13 | $174.10 | $232.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.96 / $170.14 / $1,166.24
| Professional | | $129.96 | $170.14 | $1,166.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $157.32 / $228.48
| Professional | | $129.63 | $157.32 | $228.48 |