- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $902.76 / $964.33 / $1,110.73
| Professional | | $902.76 | $964.33 | $1,110.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.45 / $790.92 / $1,264.33
| Professional | | $414.45 | $790.92 | $1,264.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.02 / $126.73 / $181.04
| Professional | | $100.02 | $126.73 | $181.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.29 / $1,170.42 / $2,072.77
| Professional | | $492.29 | $1,170.42 | $2,072.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,003.46
| Professional | | $32.34 | $32.34 | $1,003.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.06 / $1,001.10 / $1,439.94
| Professional | | $431.06 | $1,001.10 | $1,439.94 |