- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.52 / $222.18 / $1,095.80
| Professional | | $158.52 | $222.18 | $1,095.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.48 / $262.93 / $385.29
| Professional | | $198.48 | $262.93 | $385.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $48.90 / $77.63 / $168.42
| Professional | | $48.90 | $77.63 | $168.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.82 / $360.32 / $394.04
| Professional | | $310.82 | $360.32 | $394.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.34 / $250.45 / $323.39
| Professional | | $165.34 | $250.45 | $323.39 |