- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.51 / $631.16 / $1,842.64
| Professional | | $88.51 | $631.16 | $1,842.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.12 / $750.39 / $2,033.10
| Professional | | $98.12 | $750.39 | $2,033.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.10 / $436.68 / $2,365.15
| Professional | | $47.10 | $436.68 | $2,365.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.88 / $1,216.48 / $1,793.53
| Professional | | $82.88 | $1,216.48 | $1,793.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.00 / $1,446.70 / $3,620.95
| Professional | | $763.00 | $1,446.70 | $3,620.95 |