- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $575.44 / $1,230.27
| Professional | | $81.28 | $575.44 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $323.59 / $1,318.26
| Professional | | $100.00 | $323.59 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $295.12 / $1,148.15
| Professional | | $93.33 | $295.12 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $870.96 / $2,454.71
| Professional | | $114.82 | $870.96 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $102.33 / $812.83
| Professional | | $95.50 | $102.33 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $630.96 / $1,288.25
| Professional | | $91.20 | $630.96 | $1,288.25 |