- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.34 / $600.83 / $747.37
| Professional | | $75.34 | $600.83 | $747.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.13 / $321.24 / $1,063.55
| Professional | | $81.13 | $321.24 | $1,063.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.10 / $586.85 / $1,597.40
| Professional | | $94.10 | $586.85 | $1,597.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.13 / $1,301.57 / $4,774.08
| Professional | | $761.13 | $1,301.57 | $4,774.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.13 / $1,050.41 / $1,819.22
| Professional | | $730.13 | $1,050.41 | $1,819.22 |