- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.86 / $549.54 / $1,348.96
| Professional | | $75.86 | $549.54 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $602.56 / $1,995.26
| Professional | | $89.13 | $602.56 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $794.33 / $1,258.93
| Professional | | $134.90 | $794.33 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $66.07 / $691.83 / $1,659.59
| Professional | | $66.07 | $691.83 | $1,659.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $398.11 / $1,348.96
| Professional | | $63.10 | $398.11 | $1,348.96 |