- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $144.54 / $229.09
| Professional | | $114.82 | $144.54 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $107.15 / $109.65
| Professional | | $91.20 | $107.15 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $144.54 / $181.97
| Professional | | $100.00 | $144.54 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $158.49 / $302.00
| Professional | | $114.82 | $158.49 | $302.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $141.25 / $208.93
| Professional | | $100.00 | $141.25 | $208.93 |