- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.66 / $258.30 / $410.87
| Professional | | $163.66 | $258.30 | $410.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.19 / $219.05 / $329.30
| Professional | | $186.19 | $219.05 | $329.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.34 / $290.16 / $496.07
| Professional | | $177.34 | $290.16 | $496.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.69 / $333.09 / $1,927.04
| Professional | | $250.69 | $333.09 | $1,927.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.66 / $298.82 / $420.94
| Professional | | $243.66 | $298.82 | $420.94 |