- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $467.74 / $1,071.52
| Professional | | $83.18 | $467.74 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $91.20 / $109.65
| Professional | | $81.28 | $91.20 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $549.54 / $1,318.26
| Professional | | $87.10 | $549.54 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $812.83 / $1,513.56
| Professional | | $616.60 | $812.83 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $467.74 / $1,288.25
| Professional | | $75.86 | $467.74 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $912.01 / $1,096.48
| Professional | | $630.96 | $912.01 | $1,096.48 |