- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.68 / $247.16 / $311.39
| Professional | | $177.68 | $247.16 | $311.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.71 / $143.77 / $147.66
| Professional | | $133.71 | $143.77 | $147.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.71 / $285.00 / $336.30
| Professional | | $179.71 | $285.00 | $336.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.94 / $292.48 / $612.58
| Professional | | $210.94 | $292.48 | $612.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.49 / $182.77 / $345.45
| Professional | | $142.49 | $182.77 | $345.45 |