- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.09 / $124.57 / $275.83
| Professional | | $80.09 | $124.57 | $275.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.14 / $88.14 / $1,030.00
| Professional | | $88.14 | $88.14 | $1,030.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.73 / $206.39 / $592.01
| Professional | | $81.73 | $206.39 | $592.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.17 / $245.94 / $527.38
| Professional | | $182.17 | $245.94 | $527.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.76 / $242.33 / $609.04
| Professional | | $161.76 | $242.33 | $609.04 |