- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $42.42 / $314.55
| Professional | | $30.00 | $42.42 | $314.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.18 / $243.18 / $539.40
| Professional | | $243.18 | $243.18 | $539.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.00 / $260.00 / $448.00
| Professional | | $160.00 | $260.00 | $448.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.42 / $300.00 / $342.60
| Professional | | $42.42 | $300.00 | $342.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $60.00 / $91.39
| Professional | | $50.00 | $60.00 | $91.39 |