- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $42.42 / $251.64
| Professional | | $30.00 | $42.42 | $251.64 |
- 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
- $120.00 / $195.00 / $336.00
| Professional | | $120.00 | $195.00 | $336.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.42 / $240.00 / $274.08
| Professional | | $42.42 | $240.00 | $274.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $60.00 / $76.48
| Professional | | $50.00 | $60.00 | $76.48 |