- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $208.93 / $524.81
| Professional | | $138.04 | $208.93 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $1,071.52 / $5,128.61
| Professional | | $186.21 | $1,071.52 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $288.40 / $588.84
| Professional | | $190.55 | $288.40 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $426.58 / $676.08
| Professional | | $309.03 | $426.58 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $275.42 / $575.44
| Professional | | $173.78 | $275.42 | $575.44 |