- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.02 / $319.35 / $1,181.35
| Professional | | $201.02 | $319.35 | $1,181.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.75 / $369.16 / $578.53
| Professional | | $257.75 | $369.16 | $578.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.37 / $166.34 / $274.23
| Professional | | $29.37 | $166.34 | $274.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.17 / $454.97 / $746.37
| Professional | | $294.17 | $454.97 | $746.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.39 / $346.80 / $532.44
| Professional | | $275.39 | $346.80 | $532.44 |