- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $147.91 / $354.81
| Professional | | $100.00 | $147.91 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $288.40 / $2,454.71
| Professional | | $117.49 | $288.40 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $199.53 / $380.19
| Professional | | $114.82 | $199.53 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $257.04 / $363.08
| Professional | | $186.21 | $257.04 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $177.83 / $354.81
| Professional | | $97.72 | $177.83 | $354.81 |