- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $44.67 / $812.83
| Professional | | $30.20 | $44.67 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $501.19 / $724.44
| Professional | | $323.59 | $501.19 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $416.87 / $1,000.00
| Professional | | $309.03 | $416.87 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $60.26 / $75.86
| Professional | | $45.71 | $60.26 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $562.34 / $831.76
| Professional | | $38.90 | $562.34 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.77 / $60.26 / $81.28
| Professional | | $46.77 | $60.26 | $81.28 |