- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.79 / $180.43 / $368.61
| Professional | | $120.79 | $180.43 | $368.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.83 / $213.96 / $319.31
| Professional | | $152.83 | $213.96 | $319.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.74 / $210.42 / $412.23
| Professional | | $127.74 | $210.42 | $412.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.80 / $269.20 / $1,888.80
| Professional | | $172.80 | $269.20 | $1,888.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.65 / $230.39 / $438.96
| Professional | | $167.65 | $230.39 | $438.96 |