- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.34 / $196.21 / $354.60
| Professional | | $121.34 | $196.21 | $354.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.36 / $388.25 / $797.46
| Professional | | $329.36 | $388.25 | $797.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.25 / $238.13 / $378.30
| Professional | | $187.25 | $238.13 | $378.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.86 / $238.13 / $378.30
| Professional | | $120.86 | $238.13 | $378.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $256.51 / $308.18 / $895.91
| Professional | | $256.51 | $308.18 | $895.91 |