- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.04 / $203.47 / $1,034.58
| Professional | | $126.04 | $203.47 | $1,034.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.14 / $281.51 / $360.42
| Professional | | $260.14 | $281.51 | $360.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $69.31 / $236.82
| Professional | | $32.34 | $69.31 | $236.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.24 / $290.67 / $375.43
| Professional | | $231.24 | $290.67 | $375.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.30 / $208.00 / $353.99
| Professional | | $154.30 | $208.00 | $353.99 |