- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.33 / $236.01 / $329.74
| Professional | | $178.33 | $236.01 | $329.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.35 / $133.60 / $266.01
| Professional | | $36.35 | $133.60 | $266.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.78 / $262.01 / $848.86
| Professional | | $175.78 | $262.01 | $848.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.01 / $286.66 / $364.07
| Professional | | $236.01 | $286.66 | $364.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.65 / $252.79 / $352.02
| Professional | | $205.65 | $252.79 | $352.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.12 / $316.32 / $405.00
| Professional | | $262.12 | $316.32 | $405.00 |