- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.45 / $275.41 / $419.13
| Professional | | $165.45 | $275.41 | $419.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.93 / $179.81 / $2,244.00
| Professional | | $176.93 | $179.81 | $2,244.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.05 / $339.21 / $745.85
| Professional | | $162.05 | $339.21 | $745.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.41 / $604.34 / $604.34
| Professional | | $366.41 | $604.34 | $604.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.51 / $504.66 / $750.34
| Professional | | $197.51 | $504.66 | $750.34 |