- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.42 / $86.42 / $313.77
| Professional | | $86.42 | $86.42 | $313.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.46 / $92.00 / $1,951.00
| Professional | | $85.46 | $92.00 | $1,951.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.70 / $262.62 / $701.66
| Professional | | $90.70 | $262.62 | $701.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.27 / $717.87 / $717.87
| Professional | | $325.27 | $717.87 | $717.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.48 / $613.87 / $829.56
| Professional | | $288.48 | $613.87 | $829.56 |