- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.74 / $102.20 / $172.02
| Professional | | $84.74 | $102.20 | $172.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.00 / $126.00 / $126.00
| Professional | | $126.00 | $126.00 | $126.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.73 / $113.51 / $179.28
| Professional | | $83.73 | $113.51 | $179.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.53 / $98.86 / $157.06
| Professional | | $78.53 | $98.86 | $157.06 |