- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.37 / $162.26 / $264.70
| Professional | | $117.37 | $162.26 | $264.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.42 / $399.19 / $593.14
| Professional | | $374.42 | $399.19 | $593.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.60 / $227.32 / $287.16
| Professional | | $146.60 | $227.32 | $287.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.60 / $222.97 / $287.16
| Professional | | $146.60 | $222.97 | $287.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.71 / $204.92 / $672.14
| Professional | | $180.71 | $204.92 | $672.14 |