- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.47 / $49.64 / $53.26
| Professional | | $42.47 | $49.64 | $53.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.23 / $54.80 / $660.00
| Professional | | $51.23 | $54.80 | $660.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42.67 / $49.78 / $134.77
| Professional | | $42.67 | $49.78 | $134.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.60 / $120.25 / $120.25
| Professional | | $54.60 | $120.25 | $120.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.42 / $60.27 / $147.60
| Professional | | $38.42 | $60.27 | $147.60 |