- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.31 / $229.40 / $806.41
| Professional | | $196.31 | $229.40 | $806.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.10 / $304.05 / $769.46
| Professional | | $166.10 | $304.05 | $769.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.54 / $492.42 / $1,055.42
| Professional | | $188.54 | $492.42 | $1,055.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.41 / $390.74 / $910.76
| Professional | | $169.41 | $390.74 | $910.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.31 / $229.40 / $806.41
| Professional | | $196.31 | $229.40 | $806.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.74 / $753.91 / $1,065.39
| Professional | | $577.74 | $753.91 | $1,065.39 |