- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.63 / $631.16 / $1,552.51
| Professional | | $78.63 | $631.16 | $1,552.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.33 / $693.61 / $3,194.10
| Professional | | $168.33 | $693.61 | $3,194.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.55 / $574.33 / $3,919.92
| Professional | | $178.55 | $574.33 | $3,919.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.78 / $868.49 / $3,412.92
| Professional | | $176.78 | $868.49 | $3,412.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.28 / $2,487.04 / $6,893.12
| Professional | | $1,052.28 | $2,487.04 | $6,893.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $962.41 / $1,928.53 / $3,912.96
| Professional | | $962.41 | $1,928.53 | $3,912.96 |