- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.00 / $243.36 / $296.29
| Professional | | $131.00 | $243.36 | $296.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.94 / $253.31 / $341.71
| Professional | | $140.94 | $253.31 | $341.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.44 / $226.17 / $335.16
| Professional | | $129.44 | $226.17 | $335.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.60 / $378.52 / $1,966.88
| Professional | | $217.60 | $378.52 | $1,966.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.30 / $279.27 / $467.19
| Professional | | $207.30 | $279.27 | $467.19 |