- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.86 / $105.86 / $112.93
| Professional | | $105.86 | $105.86 | $112.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.00 / $186.00 / $186.00
| Professional | | $151.00 | $186.00 | $186.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $75.00 / $75.00
| Facility | | $75.00 | $75.00 | $75.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.87 / $145.43 / $211.71
| Professional | | $111.87 | $145.43 | $211.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.92 / $184.81 / $308.10
| Professional | | $100.92 | $184.81 | $308.10 |