- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.57 / $185.23 / $513.90
| Professional | | $125.57 | $185.23 | $513.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.61 / $204.01 / $204.01
| Professional | | $183.61 | $204.01 | $204.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.24 / $190.45 / $316.30
| Professional | | $138.24 | $190.45 | $316.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.79 / $218.38 / $363.89
| Professional | | $140.79 | $218.38 | $363.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.49 / $233.04 / $360.75
| Professional | | $197.49 | $233.04 | $360.75 |