- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.03 / $180.76 / $286.69
| Professional | | $140.03 | $180.76 | $286.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.32 / $202.73 / $239.77
| Professional | | $172.32 | $202.73 | $239.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.07 / $219.63 / $353.61
| Professional | | $159.07 | $219.63 | $353.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.84 / $232.90 / $1,377.92
| Professional | | $176.84 | $232.90 | $1,377.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.42 / $206.02 / $293.63
| Professional | | $172.42 | $206.02 | $293.63 |