- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.75 / $269.62 / $274.31
| Professional | | $143.75 | $269.62 | $274.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.20 / $169.17 / $318.16
| Professional | | $123.20 | $169.17 | $318.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.57 / $222.81 / $323.35
| Professional | | $141.57 | $222.81 | $323.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.21 / $359.55 / $1,853.36
| Professional | | $209.21 | $359.55 | $1,853.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.90 / $253.51 / $397.72
| Professional | | $196.90 | $253.51 | $397.72 |