- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.12 / $276.08 / $310.52
| Professional | | $134.12 | $276.08 | $310.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.86 / $598.19 / $1,915.56
| Professional | | $514.86 | $598.19 | $1,915.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.36 / $226.30 / $583.94
| Professional | | $94.36 | $226.30 | $583.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.66 / $282.22 / $583.94
| Professional | | $168.66 | $282.22 | $583.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.23 / $348.12 / $1,012.02
| Professional | | $236.23 | $348.12 | $1,012.02 |