- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.72 / $118.85 / $220.26
| Professional | | $75.72 | $118.85 | $220.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.32 / $57.94 / $100.00
| Professional | | $47.32 | $57.94 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.29 / $58.29 / $58.29
| Professional | | $58.29 | $58.29 | $58.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $142.87 / $250.02
| Professional | | $100.00 | $142.87 | $250.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.39 / $67.09 / $114.30
| Professional | | $54.39 | $67.09 | $114.30 |