- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.27 / $220.09 / $532.45
| Professional | | $142.27 | $220.09 | $532.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.68 / $193.24 / $297.69
| Professional | | $151.68 | $193.24 | $297.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.79 / $280.20 / $492.97
| Professional | | $175.79 | $280.20 | $492.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $244.70 / $378.80 / $1,905.36
| Professional | | $244.70 | $378.80 | $1,905.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.58 / $308.77 / $522.04
| Professional | | $231.58 | $308.77 | $522.04 |