- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $42.42 / $377.46
| Professional | | $30.00 | $42.42 | $377.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.18 / $243.18 / $555.66
| Professional | | $243.18 | $243.18 | $555.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.00 / $328.50 / $610.00
| Professional | | $200.00 | $328.50 | $610.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.42 / $312.83 / $408.00
| Professional | | $42.42 | $312.83 | $408.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.00 / $60.00 / $77.45
| Professional | | $50.00 | $60.00 | $77.45 |