- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.25 / $114.42 / $216.42
| Professional | | $91.25 | $114.42 | $216.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.21 / $100.21 / $1,686.00
| Professional | | $100.21 | $100.21 | $1,686.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.60 / $179.24 / $467.09
| Professional | | $91.60 | $179.24 | $467.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.46 / $204.53 / $415.04
| Professional | | $184.46 | $204.53 | $415.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.79 / $189.54 / $504.53
| Professional | | $129.79 | $189.54 | $504.53 |