- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.86 / $261.02 / $563.66
| Professional | | $168.86 | $261.02 | $563.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.30 / $277.87 / $427.92
| Professional | | $182.30 | $277.87 | $427.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.31 / $378.46 / $623.71
| Professional | | $209.31 | $378.46 | $623.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.75 / $393.80 / $767.31
| Professional | | $187.75 | $393.80 | $767.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.00 / $430.16 / $1,045.83
| Professional | | $288.00 | $430.16 | $1,045.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.37 / $215.48 / $315.52
| Professional | | $134.37 | $215.48 | $315.52 |