- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.91 / $108.91 / $610.90
| Professional | | $108.91 | $108.91 | $610.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.34 / $181.28 / $241.71
| Professional | | $106.34 | $181.28 | $241.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.47 / $265.67 / $352.48
| Professional | | $137.47 | $265.67 | $352.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.68 / $267.70 / $1,700.00
| Professional | | $145.68 | $267.70 | $1,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.00 / $259.47 / $308.80
| Professional | | $194.00 | $259.47 | $308.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.68 / $261.20 / $324.91
| Professional | | $145.68 | $261.20 | $324.91 |