- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.03 / $228.88 / $370.85
| Professional | | $114.03 | $228.88 | $370.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.09 / $174.22 / $340.09
| Professional | | $148.09 | $174.22 | $340.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.63 / $238.64 / $448.47
| Professional | | $129.63 | $238.64 | $448.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.47 / $318.95 / $1,494.45
| Professional | | $241.47 | $318.95 | $1,494.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.20 / $302.05 / $389.73
| Professional | | $241.20 | $302.05 | $389.73 |