- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.67 / $295.95 / $396.32
| Professional | | $193.67 | $295.95 | $396.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.52 / $215.12 / $307.02
| Professional | | $177.52 | $215.12 | $307.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.45 / $256.32 / $404.32
| Professional | | $194.45 | $256.32 | $404.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.69 / $306.32 / $926.11
| Professional | | $192.69 | $306.32 | $926.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $109.43
| Professional | | $32.34 | $32.34 | $109.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.91 / $356.20 / $533.47
| Professional | | $271.91 | $356.20 | $533.47 |