- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.53 / $631.16 / $1,360.48
| Professional | | $77.53 | $631.16 | $1,360.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.51 / $242.25 / $1,669.46
| Professional | | $89.51 | $242.25 | $1,669.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.02 / $323.36 / $1,660.85
| Professional | | $89.02 | $323.36 | $1,660.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,372.61 / $6,430.04 / $7,601.03
| Professional | | $3,372.61 | $6,430.04 | $7,601.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.40 / $1,040.75 / $1,862.04
| Professional | | $131.40 | $1,040.75 | $1,862.04 |