- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $208.93 / $331.13
| Professional | | $177.83 | $208.93 | $331.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $229.09 / $251.19
| Professional | | $186.21 | $229.09 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $239.88 / $309.03
| Professional | | $177.83 | $239.88 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $223.87 / $1,412.54
| Professional | | $169.82 | $223.87 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $204.17 / $302.00
| Professional | | $158.49 | $204.17 | $302.00 |