- 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
- $162.12 / $162.12 / $359.60
| Professional | | $162.12 | $162.12 | $359.60 |
- 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 / $75.00
| Professional | | $50.00 | $60.00 | $75.00 |