- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.54 / $128.08 / $442.06
| Professional | | $36.54 | $128.08 | $442.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.00 / $147.00 / $147.00
| Professional | | $147.00 | $147.00 | $147.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.59 / $139.41 / $292.89
| Professional | | $44.59 | $139.41 | $292.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.47 / $168.63 / $371.69
| Professional | | $128.47 | $168.63 | $371.69 |