- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.12 / $225.66 / $230.98
| Professional | | $125.12 | $225.66 | $230.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.05 / $224.70 / $328.77
| Professional | | $127.05 | $224.70 | $328.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.30 / $236.23 / $328.71
| Professional | | $144.30 | $236.23 | $328.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.79 / $260.33 / $1,710.56
| Professional | | $205.79 | $260.33 | $1,710.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.35 / $247.94 / $352.17
| Professional | | $198.35 | $247.94 | $352.17 |