- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.44 / $126.44 / $188.91
| Professional | | $126.44 | $126.44 | $188.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.49 / $123.25 / $1,643.00
| Professional | | $86.49 | $123.25 | $1,643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.37 / $166.60 / $350.04
| Professional | | $111.37 | $166.60 | $350.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.49 / $358.02 / $358.02
| Professional | | $161.49 | $358.02 | $358.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.10 / $341.42 / $432.31
| Professional | | $144.10 | $341.42 | $432.31 |