- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.62 / $575.44 / $1,071.52
| Professional | | $77.62 | $575.44 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $645.65 / $1,202.26
| Professional | | $100.00 | $645.65 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $147.91
| Professional | | $32.36 | $33.11 | $147.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $190.55 / $1,584.89
| Professional | | $117.49 | $190.55 | $1,584.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.10 / $616.60 / $1,445.44
| Professional | | $87.10 | $616.60 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $831.76 / $1,318.26
| Professional | | $109.65 | $831.76 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.28 / $537.03 / $1,230.27
| Professional | | $81.28 | $537.03 | $1,230.27 |