- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.88 / $196.80 / $349.31
| Professional | | $117.88 | $196.80 | $349.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.76 / $139.69 / $217.77
| Professional | | $111.76 | $139.69 | $217.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.75 / $208.82 / $314.64
| Professional | | $121.75 | $208.82 | $314.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.80 / $240.45 / $1,710.56
| Professional | | $199.80 | $240.45 | $1,710.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.58 / $230.72 / $302.29
| Professional | | $191.58 | $230.72 | $302.29 |