- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.64 / $208.82 / $360.40
| Professional | | $107.64 | $208.82 | $360.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.00 / $266.00 / $266.00
| Professional | | $266.00 | $266.00 | $266.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.39 / $205.18 / $300.02
| Professional | | $123.39 | $205.18 | $300.02 |
- 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
- $133.43 / $165.97 / $340.29
| Professional | | $133.43 | $165.97 | $340.29 |