- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.96 / $212.26 / $403.19
| Professional | | $124.96 | $212.26 | $403.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.86 / $165.86 / $305.14
| Professional | | $165.86 | $165.86 | $305.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.12 / $236.96 / $400.92
| Professional | | $129.12 | $236.96 | $400.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.61 / $338.18 / $1,692.80
| Professional | | $216.61 | $338.18 | $1,692.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.28 / $255.60 / $434.22
| Professional | | $212.28 | $255.60 | $434.22 |