- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.36 / $172.33 / $274.64
| Professional | | $139.36 | $172.33 | $274.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.66 / $209.12 / $2,642.00
| Professional | | $196.66 | $209.12 | $2,642.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.42 / $257.36 / $587.74
| Professional | | $170.42 | $257.36 | $587.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.69 / $671.08 / $671.08
| Professional | | $299.69 | $671.08 | $671.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.02 / $283.45 / $775.48
| Professional | | $185.02 | $283.45 | $775.48 |