- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.05 / $188.23 / $274.64
| Professional | | $123.05 | $188.23 | $274.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.26 / $265.00 / $360.42
| Professional | | $175.26 | $265.00 | $360.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.45 / $267.68 / $419.01
| Professional | | $206.45 | $267.68 | $419.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.55 / $293.55 / $293.55
| Professional | | $293.55 | $293.55 | $293.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.53 / $194.79 / $305.47
| Professional | | $29.53 | $194.79 | $305.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.15 / $282.87 / $466.74
| Professional | | $223.15 | $282.87 | $466.74 |