- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.11 / $275.42 / $870.96
| Professional | | $85.11 | $275.42 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $2,570.40 / $13,803.84
| Professional | | $91.20 | $2,570.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $602.56 / $1,995.26
| Professional | | $83.18 | $602.56 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $758.58 / $1,621.81
| Professional | | $724.44 | $758.58 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $229.09 / $1,698.24
| Professional | | $75.86 | $229.09 | $1,698.24 |