- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.94 / $278.85 / $303.19
| Professional | | $147.94 | $278.85 | $303.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.44 / $176.38 / $349.40
| Professional | | $128.44 | $176.38 | $349.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.34 / $262.01 / $389.65
| Professional | | $148.34 | $262.01 | $389.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.31 / $392.77 / $2,033.68
| Professional | | $235.31 | $392.77 | $2,033.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.10 / $293.76 / $467.74
| Professional | | $215.10 | $293.76 | $467.74 |