- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.61 / $93.61 / $144.36
| Professional | | $93.61 | $93.61 | $144.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.19 / $129.83 / $2,116.00
| Professional | | $126.19 | $129.83 | $2,116.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.13 / $172.64 / $384.73
| Professional | | $109.13 | $172.64 | $384.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.57 / $390.24 / $390.24
| Professional | | $173.57 | $390.24 | $390.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.31 / $212.53 / $452.93
| Professional | | $137.31 | $212.53 | $452.93 |