- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.03 / $228.88 / $601.34
| Professional | | $114.03 | $228.88 | $601.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.85 / $192.10 / $359.71
| Professional | | $116.85 | $192.10 | $359.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.07 / $226.55 / $456.58
| Professional | | $117.07 | $226.55 | $456.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.36 / $326.20 / $1,494.45
| Professional | | $211.36 | $326.20 | $1,494.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.03 / $298.39 / $584.75
| Professional | | $196.03 | $298.39 | $584.75 |