- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.30 / $115.07 / $498.84
| Professional | | $88.30 | $115.07 | $498.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $58.29 / $58.29 / $167.41
| Professional | | $58.29 | $58.29 | $167.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.44 / $142.87 / $207.16
| Professional | | $121.44 | $142.87 | $207.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.30 / $200.02 / $2,500.00
| Professional | | $194.30 | $200.02 | $2,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $47.52 / $71.27 / $111.81
| Professional | | $47.52 | $71.27 | $111.81 |