- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.53 / $157.66 / $191.08
| Professional | | $155.53 | $157.66 | $191.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.00 / $306.00 / $306.00
| Professional | | $306.00 | $306.00 | $306.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.41 / $262.35 / $384.00
| Professional | | $80.41 | $262.35 | $384.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.53 / $267.61 / $1,419.41
| Professional | | $181.53 | $267.61 | $1,419.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.60 / $228.16 / $339.79
| Professional | | $175.60 | $228.16 | $339.79 |