- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.83 / $186.76 / $277.95
| Professional | | $169.83 | $186.76 | $277.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $185.33 / $186.98 / $2,116.00
| Professional | | $185.33 | $186.98 | $2,116.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.03 / $341.39 / $756.70
| Professional | | $167.03 | $341.39 | $756.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.66 / $610.75 / $610.75
| Professional | | $377.66 | $610.75 | $610.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.91 / $525.27 / $739.45
| Professional | | $205.91 | $525.27 | $739.45 |