- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.44 / $179.25 / $278.97
| Professional | | $156.44 | $179.25 | $278.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.03 / $217.03 / $217.03
| Professional | | $217.03 | $217.03 | $217.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.80 / $313.70 / $587.16
| Professional | | $196.80 | $313.70 | $587.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.80 / $292.02 / $400.00
| Professional | | $196.80 | $292.02 | $400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.83 / $226.74 / $655.07
| Professional | | $164.83 | $226.74 | $655.07 |