- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.18 / $966.70 / $1,114.07
| Professional | | $744.18 | $966.70 | $1,114.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.38 / $718.57 / $845.38
| Professional | | $77.38 | $718.57 | $845.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.58 / $2,464.94 / $2,581.10
| Professional | | $234.58 | $2,464.94 | $2,581.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $670.00 / $670.00 / $670.00
| Professional | | $670.00 | $670.00 | $670.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $65.62 / $281.95 / $557.17
| Professional | | $65.62 | $281.95 | $557.17 |