- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.50 / $108.70 / $1,208.11
| Professional | | $90.50 | $108.70 | $1,208.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $27.89 / $92.56 / $1,030.00
| Professional | | $27.89 | $92.56 | $1,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.42 / $728.49 / $2,528.90
| Professional | | $75.42 | $728.49 | $2,528.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.29 / $1,030.90 / $2,250.81
| Professional | | $193.29 | $1,030.90 | $2,250.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.74 / $954.02 / $2,736.14
| Professional | | $82.74 | $954.02 | $2,736.14 |