- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.25 / $161.69 / $181.20
| Professional | | $113.25 | $161.69 | $181.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.48 / $231.22 / $315.00
| Professional | | $108.48 | $231.22 | $315.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.26 / $165.36 / $302.24
| Professional | | $132.26 | $165.36 | $302.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,370.53 / $1,788.46 / $2,203.92
| Professional | | $1,370.53 | $1,788.46 | $2,203.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.11 / $113.57 / $169.60
| Professional | | $93.11 | $113.57 | $169.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.86 / $158.80 / $310.07
| Professional | | $113.86 | $158.80 | $310.07 |