- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.66 / $213.29 / $376.79
| Professional | | $138.66 | $213.29 | $376.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.74 / $260.20 / $765.01
| Professional | | $220.74 | $260.20 | $765.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.72 / $227.58 / $605.58
| Professional | | $148.72 | $227.58 | $605.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.80 / $308.38 / $605.58
| Professional | | $198.80 | $308.38 | $605.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.10 / $278.45 / $860.87
| Professional | | $222.10 | $278.45 | $860.87 |