- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.31 / $181.00 / $207.23
| Professional | | $131.31 | $181.00 | $207.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.52 / $211.30 / $305.20
| Professional | | $177.52 | $211.30 | $305.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.63 / $273.77 / $405.86
| Professional | | $188.63 | $273.77 | $405.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.50 / $232.89 / $362.38
| Professional | | $199.50 | $232.89 | $362.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.31 / $181.00 / $207.23
| Professional | | $131.31 | $181.00 | $207.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.68 / $262.45 / $380.52
| Professional | | $176.68 | $262.45 | $380.52 |