- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.03 / $167.88 / $792.82
| Professional | | $140.03 | $167.88 | $792.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.97 / $257.35 / $350.68
| Professional | | $150.97 | $257.35 | $350.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.00 / $361.50 / $545.37
| Professional | | $239.00 | $361.50 | $545.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.04 / $366.84 / $1,147.11
| Professional | | $219.04 | $366.84 | $1,147.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.47 / $355.59 / $475.39
| Professional | | $272.47 | $355.59 | $475.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.04 / $362.25 / $471.77
| Professional | | $219.04 | $362.25 | $471.77 |