- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $151.36 / $537.03
| Professional | | $79.43 | $151.36 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $190.55 / $446.68
| Professional | | $162.18 | $190.55 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $158.49 / $398.11
| Professional | | $100.00 | $158.49 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.90 / $204.17 / $204.17
| Professional | | $134.90 | $204.17 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $144.54 / $288.40
| Professional | | $83.18 | $144.54 | $288.40 |