- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.56 / $73.73 / $108.52
| Professional | | $72.56 | $73.73 | $108.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,744.00 / $2,002.00 / $3,944.00
| Professional | | $1,744.00 | $2,002.00 | $3,944.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.28 / $89.28 / $89.28
| Professional | | $89.28 | $89.28 | $89.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.35 / $230.06 / $230.06
| Professional | | $103.35 | $230.06 | $230.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.61 / $112.23 / $265.85
| Professional | | $80.61 | $112.23 | $265.85 |