- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.61 / $170.81 / $240.86
| Professional | | $146.61 | $170.81 | $240.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.80 / $186.82 / $186.82
| Professional | | $158.80 | $186.82 | $186.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.81 / $228.75 / $316.89
| Professional | | $149.81 | $228.75 | $316.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.59 / $231.19 / $2,295.00
| Professional | | $173.59 | $231.19 | $2,295.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.15 / $204.52 / $300.27
| Professional | | $165.15 | $204.52 | $300.27 |