- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.18 / $226.55 / $363.96
| Professional | | $155.18 | $226.55 | $363.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.00 / $241.18 / $348.40
| Professional | | $205.00 | $241.18 | $348.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.23 / $351.08 / $597.09
| Professional | | $220.23 | $351.08 | $597.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.53 / $384.17 / $620.02
| Professional | | $227.53 | $384.17 | $620.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.18 / $226.55 / $363.96
| Professional | | $155.18 | $226.55 | $363.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.44 / $379.54 / $612.94
| Professional | | $245.44 | $379.54 | $612.94 |