- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.41 / $581.28 / $1,060.73
| Professional | | $76.41 | $581.28 | $1,060.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.75 / $353.13 / $577.85
| Professional | | $66.75 | $353.13 | $577.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.12 / $560.87 / $1,214.80
| Professional | | $82.12 | $560.87 | $1,214.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $647.28 / $875.30 / $4,774.08
| Professional | | $647.28 | $875.30 | $4,774.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.66 / $801.42 / $1,395.74
| Professional | | $644.66 | $801.42 | $1,395.74 |