- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.07 / $245.76 / $2,848.03
| Professional | | $86.07 | $245.76 | $2,848.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.37 / $236.68 / $1,694.46
| Professional | | $101.37 | $236.68 | $1,694.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.63 / $974.53 / $1,740.24
| Professional | | $136.63 | $974.53 | $1,740.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $1,226.14 / $1,542.57
| Professional | | $32.34 | $1,226.14 | $1,542.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.28 / $194.78 / $1,870.87
| Professional | | $158.28 | $194.78 | $1,870.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.99 / $1,246.05 / $2,013.88
| Professional | | $960.99 | $1,246.05 | $2,013.88 |