- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.41 / $229.75 / $455.78
| Professional | | $153.41 | $229.75 | $455.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.69 / $181.01 / $276.52
| Professional | | $155.69 | $181.01 | $276.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.98 / $255.76 / $414.11
| Professional | | $184.98 | $255.76 | $414.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.81 / $286.95 / $2,148.96
| Professional | | $223.81 | $286.95 | $2,148.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.56 / $276.50 / $379.81
| Professional | | $223.56 | $276.50 | $379.81 |