- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $149.06 / $231.14 / $362.00
| Professional | | $149.06 | $231.14 | $362.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.71 / $257.20 / $408.97
| Professional | | $156.71 | $257.20 | $408.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25.54 / $147.62 / $220.25
| Professional | | $25.54 | $147.62 | $220.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.85 / $282.45 / $429.89
| Professional | | $194.85 | $282.45 | $429.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.06 / $260.41 / $491.04
| Professional | | $225.06 | $260.41 | $491.04 |