- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.00 / $100.00 / $256.87
| Professional | | $97.00 | $100.00 | $256.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.69 / $187.14 / $336.92
| Professional | | $107.69 | $187.14 | $336.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.33 / $161.87 / $332.21
| Professional | | $84.33 | $161.87 | $332.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.28 / $217.49 / $318.77
| Professional | | $137.28 | $217.49 | $318.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.04 / $196.13 / $471.82
| Professional | | $114.04 | $196.13 | $471.82 |