- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.55 / $287.02 / $598.36
| Professional | | $174.55 | $287.02 | $598.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $496.00 / $496.00 / $496.00
| Professional | | $496.00 | $496.00 | $496.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.72 / $364.26 / $784.55
| Professional | | $181.72 | $364.26 | $784.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.70 / $418.86 / $882.81
| Professional | | $331.70 | $418.86 | $882.81 |