- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.32 / $223.31 / $283.94
| Professional | | $181.32 | $223.31 | $283.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.25 / $261.45 / $359.01
| Professional | | $166.25 | $261.45 | $359.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.60 / $282.68 / $404.51
| Professional | | $183.60 | $282.68 | $404.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.94 / $299.32 / $2,040.64
| Professional | | $232.94 | $299.32 | $2,040.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.38 / $276.99 / $397.44
| Professional | | $228.38 | $276.99 | $397.44 |