- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $234.42 / $1,023.29
| Professional | | $151.36 | $234.42 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $288.40 / $676.08
| Professional | | $186.21 | $288.40 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $478.63
| Professional | | $309.03 | $416.87 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $295.12 / $501.19
| Professional | | $158.49 | $295.12 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.20 / $204.17 / $446.68
| Professional | | $112.20 | $204.17 | $446.68 |