- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.80 / $114.86 / $1,041.30
| Professional | | $105.80 | $114.86 | $1,041.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.66 / $165.46 / $1,056.63
| Professional | | $99.66 | $165.46 | $1,056.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.89 / $757.24 / $1,327.13
| Professional | | $110.89 | $757.24 | $1,327.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.16 / $231.02 / $1,192.97
| Professional | | $100.16 | $231.02 | $1,192.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.80 / $114.86 / $1,041.30
| Professional | | $105.80 | $114.86 | $1,041.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $766.69 / $1,047.65 / $1,354.73
| Professional | | $766.69 | $1,047.65 | $1,354.73 |