- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.62 / $900.89 / $1,201.19
| Professional | | $24.62 | $900.89 | $1,201.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.72 / $31.72 / $42.19
| Professional | | $31.72 | $31.72 | $42.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.63 / $1,077.57 / $1,472.74
| Professional | | $47.63 | $1,077.57 | $1,472.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.08 / $1,532.34 / $2,929.32
| Professional | | $1,184.08 | $1,532.34 | $2,929.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $888.10 / $1,211.19 / $2,937.62
| Professional | | $888.10 | $1,211.19 | $2,937.62 |