- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.61 / $118.34 / $155.00
| Professional | | $75.61 | $118.34 | $155.00 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $114.88 / $114.88 / $114.88
| Professional | 25 | $114.88 | $114.88 | $114.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.57 / $140.71 / $177.62
| Professional | | $131.57 | $140.71 | $177.62 |
- Facility/Professional
- Professional
- Modifier
- 25
- Low / Median / High Price
- $98.50 / $98.50 / $98.50
| Professional | 25 | $98.50 | $98.50 | $98.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.56 / $117.10 / $128.81
| Professional | | $75.56 | $117.10 | $128.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $61.09 / $100.45 / $182.10
| Professional | | $61.09 | $100.45 | $182.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.60 / $126.71 / $160.29
| Professional | | $91.60 | $126.71 | $160.29 |