- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.42 / $673.51 / $890.34
| Professional | | $34.42 | $673.51 | $890.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.21 / $801.00 / $1,268.23
| Professional | | $55.21 | $801.00 | $1,268.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.21 / $55.21 / $1,348.15
| Facility | | $55.21 | $55.21 | $1,348.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $55.21 / $759.74 / $1,348.15
| Professional | | $55.21 | $759.74 | $1,348.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $32.76 / $724.91 / $1,015.37
| Facility | | $32.76 | $724.91 | $1,015.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.72 / $844.38 / $1,944.79
| Professional | | $52.72 | $844.38 | $1,944.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.45 / $1,220.91 / $1,452.46
| Professional | | $1,031.45 | $1,220.91 | $1,452.46 |