- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.34 / $248.51 / $248.51
| Professional | | $157.34 | $248.51 | $248.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.65 / $332.21 / $364.78
| Professional | | $195.65 | $332.21 | $364.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.47 / $226.86 / $354.30
| Professional | | $163.47 | $226.86 | $354.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.40 / $396.91 / $1,665.76
| Professional | | $230.40 | $396.91 | $1,665.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.40 / $296.70 / $458.27
| Professional | | $230.40 | $296.70 | $458.27 |