- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.05 / $130.71 / $130.71
| Professional | | $64.05 | $130.71 | $130.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.95 / $106.31 / $1,228.00
| Professional | | $102.95 | $106.31 | $1,228.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.09 / $132.66 / $443.82
| Professional | | $91.09 | $132.66 | $443.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.88 / $220.35 / $233.86
| Professional | | $114.88 | $220.35 | $233.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.47 / $112.36 / $304.51
| Professional | | $82.47 | $112.36 | $304.51 |