- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.15 / $175.40 / $264.33
| Professional | | $168.15 | $175.40 | $264.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.32 / $194.32 / $194.32
| Professional | | $194.32 | $194.32 | $194.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.10 / $151.07 / $282.89
| Professional | | $139.10 | $151.07 | $282.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.77 / $247.25 / $355.78
| Professional | | $180.77 | $247.25 | $355.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.41 / $231.22 / $467.42
| Professional | | $147.41 | $231.22 | $467.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.27 / $180.27 / $180.27
| Professional | | $180.27 | $180.27 | $180.27 |