- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.03 / $108.32 / $176.46
| Professional | | $101.03 | $108.32 | $176.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.00 / $87.00 / $87.00
| Professional | | $87.00 | $87.00 | $87.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.61 / $103.04 / $147.24
| Professional | | $68.61 | $103.04 | $147.24 |
- 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
- $71.47 / $94.57 / $140.97
| Professional | | $71.47 | $94.57 | $140.97 |