- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.39 / $216.09 / $216.09
| Professional | | $212.39 | $216.09 | $216.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.80 / $231.11 / $253.76
| Professional | | $184.80 | $231.11 | $253.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.62 / $243.39 / $305.70
| Professional | | $188.62 | $243.39 | $305.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.07 / $246.29 / $1,418.24
| Professional | | $175.07 | $246.29 | $1,418.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.44 / $213.97 / $326.52
| Professional | | $161.44 | $213.97 | $326.52 |