- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $151.36 / $269.15
| Professional | | $114.82 | $151.36 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $281.84 / $426.58
| Professional | | $173.78 | $281.84 | $426.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $363.08
| Professional | | $186.21 | $288.40 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $288.40 / $288.40
| Professional | | $213.80 | $288.40 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $245.47 / $891.25
| Professional | | $128.82 | $245.47 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $239.88 / $426.58
| Professional | | $134.90 | $239.88 | $426.58 |