- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.15 / $230.76 / $346.94
| Professional | | $172.15 | $230.76 | $346.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.89 / $241.27 / $400.07
| Professional | | $178.89 | $241.27 | $400.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.92 / $265.10 / $427.54
| Professional | | $175.92 | $265.10 | $427.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,355.44 / $1,418.24 / $1,562.63
| Professional | | $1,355.44 | $1,418.24 | $1,562.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.11 / $277.62 / $436.99
| Professional | | $179.11 | $277.62 | $436.99 |