- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.41 / $587.59 / $964.32
| Professional | | $80.41 | $587.59 | $964.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.65 / $492.42 / $1,359.01
| Professional | | $83.65 | $492.42 | $1,359.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.39 / $465.56 / $1,292.42
| Professional | | $94.39 | $465.56 | $1,292.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,322.73 / $4,448.24 / $5,244.98
| Professional | | $2,322.73 | $4,448.24 | $5,244.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.17 / $1,024.24 / $1,541.14
| Professional | | $686.17 | $1,024.24 | $1,541.14 |