- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $155.51 / $189.21 / $230.68
| Professional | | $155.51 | $189.21 | $230.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.58 / $412.00 / $564.50
| Professional | | $317.58 | $412.00 | $564.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.77 / $418.02 / $592.69
| Professional | | $218.77 | $418.02 | $592.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.25 / $411.83 / $1,192.96
| Professional | | $230.25 | $411.83 | $1,192.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.25 / $411.83 / $484.52
| Professional | | $230.25 | $411.83 | $484.52 |