- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.02 / $169.50 / $473.91
| Professional | | $167.02 | $169.50 | $473.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.80 / $498.80 / $498.80
| Professional | | $498.80 | $498.80 | $498.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.52 / $356.87 / $928.35
| Professional | | $190.52 | $356.87 | $928.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.17 / $509.35 / $846.24
| Professional | | $193.17 | $509.35 | $846.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.27 / $613.91 / $1,695.07
| Professional | | $552.27 | $613.91 | $1,695.07 |