- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.39 / $264.32 / $317.20
| Professional | | $192.39 | $264.32 | $317.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.07 / $346.88 / $420.00
| Professional | | $186.07 | $346.88 | $420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.54 / $275.76 / $371.56
| Professional | | $203.54 | $275.76 | $371.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.72 / $253.72 / $253.72
| Professional | | $253.72 | $253.72 | $253.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.75 / $249.26 / $325.47
| Professional | | $202.75 | $249.26 | $325.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.58 / $266.17 / $465.80
| Professional | | $199.58 | $266.17 | $465.80 |