- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.34 / $346.70 / $1,061.15
| Professional | | $232.34 | $346.70 | $1,061.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.05 / $414.18 / $624.17
| Professional | | $293.05 | $414.18 | $624.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.49 / $243.32 / $323.46
| Professional | | $27.49 | $243.32 | $323.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.03 / $492.20 / $704.53
| Professional | | $336.03 | $492.20 | $704.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.11 / $402.21 / $646.46
| Professional | | $304.11 | $402.21 | $646.46 |