- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.62 / $326.00 / $1,045.20
| Professional | | $181.62 | $326.00 | $1,045.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $235.51 / $382.48 / $579.37
| Professional | | $235.51 | $382.48 | $579.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.59 / $230.29 / $321.68
| Professional | | $28.59 | $230.29 | $321.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.06 / $470.78 / $784.88
| Professional | | $264.06 | $470.78 | $784.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.19 / $362.97 / $583.52
| Professional | | $295.19 | $362.97 | $583.52 |