- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $144.54 / $398.11
| Professional | | $100.00 | $144.54 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $128.82 / $158.49
| Professional | | $117.49 | $128.82 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $165.96 / $323.59
| Professional | | $109.65 | $165.96 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.97 / $208.93 / $309.03
| Professional | | $181.97 | $208.93 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $151.36 / $281.84
| Professional | | $97.72 | $151.36 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $208.93 / $257.04
| Professional | | $134.90 | $208.93 | $257.04 |