- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.12 / $656.00 / $2,642.33
| Professional | | $78.12 | $656.00 | $2,642.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.28 / $1,213.00 / $1,213.00
| Professional | | $634.28 | $1,213.00 | $1,213.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.54 / $805.18 / $1,739.19
| Professional | | $94.54 | $805.18 | $1,739.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.05 / $992.64 / $2,023.98
| Professional | | $120.05 | $992.64 | $2,023.98 |