- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.01 / $255.25 / $343.61
| Professional | | $182.01 | $255.25 | $343.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.14 / $189.14 / $189.14
| Professional | | $189.14 | $189.14 | $189.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.43 / $315.87 / $566.08
| Professional | | $218.43 | $315.87 | $566.08 |
- 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
- $1,561.80 / $1,561.80 / $1,848.30
| Professional | | $1,561.80 | $1,561.80 | $1,848.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.09 / $288.45 / $508.83
| Professional | | $80.09 | $288.45 | $508.83 |