- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.48 / $631.16 / $1,131.40
| Professional | | $75.48 | $631.16 | $1,131.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.68 / $592.28 / $1,490.43
| Professional | | $78.68 | $592.28 | $1,490.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.15 / $618.29 / $984.39
| Professional | | $67.15 | $618.29 | $984.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.23 / $905.98 / $1,301.38
| Professional | | $143.23 | $905.98 | $1,301.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.85 / $884.43 / $1,557.32
| Professional | | $471.85 | $884.43 | $1,557.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.36 / $102.31 / $102.31
| Professional | | $65.36 | $102.31 | $102.31 |