- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.70 / $167.72 / $239.38
| Professional | | $165.70 | $167.72 | $239.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.58 / $182.47 / $2,244.00
| Professional | | $180.58 | $182.47 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.15 / $290.43 / $646.91
| Professional | | $163.15 | $290.43 | $646.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.98 / $527.69 / $527.69
| Professional | | $367.98 | $527.69 | $527.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.45 / $294.48 / $638.89
| Professional | | $167.45 | $294.48 | $638.89 |