- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.15 / $218.78 / $478.63
| Professional | | $107.15 | $218.78 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $204.17 / $323.59
| Professional | | $138.04 | $204.17 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $223.87 / $389.05
| Professional | | $123.03 | $223.87 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $100.00 / $323.59
| Professional | | $32.36 | $100.00 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $223.87 / $398.11
| Professional | | $123.03 | $223.87 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $223.87 / $416.87
| Professional | | $141.25 | $223.87 | $416.87 |